LipoDissolve Injections For the Treatment of Lipomas

LipoDissolve, or the introduction of a chemical formulation by injection to treat spot areas of undesired fat for cosmetic purposes, remains a controversial and non-FDA approved procedure at this point in time. Despite these issues, I have found in the past 3 years in my practice a role for LipoDissolve if it is used judiciously and with good patient selection. I have not experienced any of the complications or problems that I have read about on the internet and I suspect that rigid patient selection, keeping the injections less than 100 per session, and good sterile technique are the reasons why. One application that I have found LipoDissolve injections particularly useful is in the treatment of lipomas.

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Lipomas are fatty tumors that can appear anywhere on the body from the scalp to the legs. They are soft, easily moveable (non-adherent) masses beneath the skin that are always round in diameter. They are usually right under the skin and are very slow growing. Most patients seen usually just have one in isolation. There are, however, some patients who have a familial lipomatosis syndrome in which they develop many lipomas throughout their body continously over their lifetime. Lipomas are traditionally treated by excision which removes them in their entirety, establishes their pathology by visual and microscopic examination (if sent to a pathologist) and leaves a residual scar. In some locations, and at the desire of some patients, a scar is not wanted nor is any type of surgical procedure if possible. LipoDissolve offers a non-surgical alternative to traditional excision for some lipomas. If the excision will leave a scar over a prominent area (e.g., the shoulder of a woman) and you are fairly certain that the mass is a lipoma by examination and history, then injection treatment are an option.

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I have found that full-strength LipoDissolve injections can work quite well in the nearly 15 lipomas that I have treated thus far in the past two years. The concept is that it is a series of injections, spaced four to six weeks apart, to either reduce the size of the lipoma or completely remove it. In the nine patients (14 lipomas) that I have treated, the average number of injection sessions is nearly 5 (4.8) per patient. This does not take into account that the largest of the lipomas that I have treated (14 x 10 cms) took eight injection sessions while very small ones (2 x 2 cms) may take only one or two injections. Patients will experience a large amount of swelling for the first week and some discomfort which is typical but not lifestyle-limiting.

Since lipomas represent a concentrated nucleus of fat, it is not surprising that LipoDissolve injections can be effective. Its use, however, is not as efficient as surgery (and insurance does not cover the procedure) but it does save a scar and, in large lipomas, the risk of a fluid build-up after surgery or the need for postoperative drains. Before treatment, one has to be fairly certain that the mass is indeed a lipoma. An MRI may be done if necessary to establish the diagnosis in larger lipomas. I have not yet seen a recurrence in any lipomas that I have treated but it is too early to be absolutely certain of that in my present patient series.

LipoDissolve Injections For the Treatment of Lipomas

Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, operates a private practice at Clarian North and West Medical Centers in suburban Indianapolis. He writes a daily blogs on topics and trends in plastic surgery at http://www.exploreplasticsurgery.com

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Laser Treatment of Scars - Does it Work?

Scars are a source of frequent concern, whether they be young just after an injury or a surgery or whether they have been present for years. Lasers have caught much fascination for many applications and their use in medicine is not exception. In my Indianapolis plastic surgery practice, I get frequent in-office questions and e-mails inquiring about removing or improving their scars with a 'laser'.

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The concept of scar treatment using laser resurfacing employs CO2 or erbium laser technology. These lasers work by their light energy being strongly absorbed by water, turning into heat and resulting in skin tissue vaporization. Recontouring of scars, particularly on the face, has become popularized in recent years. Through control of the laser beam and the power behind it, predictable vaporization of tissue occurs resulting in better control compared to traditional dermabrasion.

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Whether laser resurfacing is effective for any scar depends on numerous characteristics about it. Laser are NOT effective for all scars and, as a matter of fact, are really only effective for a small number of them. Laser resurfacing is most effective for many small scars that are clustered together (such as fine acne scars) or very shallow or raised scars that would not benefit from surgical revision. It is not effective for changing a scar's color, whether it be getting redness to fade or bringing pigment back to a white scar.

CO2 lasers go deeper (remove more of the outer skin layer) and, in general, are more effective. They have a long history of use since the early 1990s and their effects are well known from full face laser resurfacing for wrinkles and aging. While erbium lasers do not go as deep and cause less skin injury than the CO2, this is countered by an overall decrease in how much improvement is obtained. Therefore, erbmium lasers should only be used in resurfacing skin of very slight scars that qualify or after an initial CO2 laser resurfacing treatment.

Regardless of the system, the goals of laser scar treatment are (1) to soften the transition between the irregularity of the scar and the intact skin surrounding it and (2) to stimulate collagen production within the scarred area. It may take more than one treatment to get the best result but it is far better to be not go too deep. More laser treatments can always be done. Treatment with either laser system has the potential to cause some transient hyperpigmentation. While this process is self-limiting, its resolution may be hastened with bleaching creams.

In properly selected patients, laser resurfacing can yield some improvement (maybe 30 - 50%) but complete elimination is never possible. Collagen remodeling of the scar improvement can continue for up to 6 months after treatment, so re-treatment of residual scars is postponed for at least that long. Resurfacing with either a CO2 or Er:YAG laser may be beneficial. After the initial treatment, allow with the erbium laser requires less time between treatments. In either case, expect some postoperative redness which may last for up to 12 weeks.

Laser Treatment of Scars - Does it Work?

Dr Barry Eppley is a board-certified plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com Dr. Eppley can be heard on his weekly radio show, Doc Chat, on WXNT 1430AM Indianapolis on Saturday afternoons.

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The Cause, Symptoms, and Treatment of the Tailor's Bunion

Bunions are a well known and much reviled foot deformity involving a prominent big toe joint. The issues regarding pain in shoes and pressure on the prominent big toe joint are generally understood by the general public, and many people seek wider shoes or surgery to have this potentially painful deformity corrected. Of lesser 'fame', but no less important is the Tailor's bunion. This article will discuss this deformity, and how it can be treated.

The joint at the base of the little toe, called the 5th metatarsal phalangeal joint, is somewhat different than the joint at the base of the big toe, where a traditional bunion is located. Its anatomic function in sharing the weight of the body and propelling the foot during walking is different, so therefore its shape and structure will differ from the big toe joint on the other side of the foot. However, a similar deformity can occur generally for the same reasons bunions occur at the big toe joint, leading to pain and a prominent bone against the side of the shoe. In essence, a Tailor's bunion (also called a bunionette) is either an enlargement of the end of the 5th metatarsal bone outward against the side of the foot, or it is a spreading or bowing of this bone away from the foot, causing the same pressure. The result is pressure of the joint against the skin on the outside of the foot, on the exact opposite end of where a traditional bunion develops. Tight shoes will initially aggravate this site, causing skin irritation where the rubbing occurs. Eventually, the irritation will spread to the tissue underneath the skin, and a protective fluid bag called a bursa may develop to pad the surface between the skin and the prominent bone. In time, this bag itself may become inflamed, and the direct tissue covering the joint will follow suit, as an inflammatory condition called capsulitis develops. In advanced cases, pain and irritation can develop even in the absence of a shoe, simply with pressure from barefoot walking.

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Traditional myth holds that the name 'Tailor's bunion' is derived from the way tailor's would sit and sew, with the feet cross-legged and underneath the body. In this position, the outside of the foot receives great pressure, and the little toe joint would therefore become irritated and inflamed after awhile. Certainly not seen only in tailors, this condition in actuality has its origins in genetics and foot structure. If one is born with a foot that is somewhat more flexible and mobile, the resulting excess motion will eventually lead to a migration of the 5th metatarsal bone away from the rest of the foot. The little toe, on the other hand, will migrate inward toward the toe next to it, leading to the prominent area on the outside of the little toe joint seen in a Tailor's bunion. If the foot is more stable structurally, a Tailor's bunion can still develop through a process of mechanical irritation on the bone itself as a enlargement or spur of the side of the bone slowly grows over time in some people. Tight shoes do not really cause this condition, but they certainly will encourage inflammation of the tissue over the bone, leading to pain and a definite awareness of the deformity if it was not noticed before.

Treatment for Tailor's bunions can be as simple as changing shoes to as complicated as reconstructive surgery. One of the first things that needs to be employed when treating this condition is to look at the shoes worn on a daily basis. The majority of the time when a Tailor's bunion is painful, these shoes will be narrow or pointed. Women's dress shoes, and certain types of men's dress shoes or reinforced boots will be in this category. Sometimes a simple conversion to a wider or more box-shaped shoe will alleviate all discomfort. In advanced cases, however, even roomier shoes will cause discomfort. This is mainly due to the inflammation occurring under the skin. In some cases, gel, foam, or felt padding can be used to help decrease joint pressure, although this tends to increase the 'bulk' of the foot in the shoe, and may have the opposite effect by making the shoe tighter. The inflammation itself can be treated with anti-inflammatory medications or injections, although these do not have any effect on the actual cause of structural irritation of the joint. In some cases, the use of prescription inserts (orthotics) can stabilize the 5th metatarsal, and limit the amount of instability, leading to a lessening of Tailor's bunion symptoms. Long term use of orthotics may even help limit the development of a Tailor's bunion outright, although use must begin at an early age.

In order to permanently correct a Tailor's bunion, and eliminate the shoe irritation from the equation, surgery is required. Surgery essentially involves removal of the bone prominence. How this is done can vary depending on the nature of the bone deformity. If the side of the bone is simply enlarged, the surgeon can shave the enlarged portion off and this will be enough to relieve the symptoms. Healing for this is relatively quick, with most patients returning to a regular shoe within a few weeks, and time off the foot is usually limited to only a few days after surgery. If the bone position is abnormal, and the 5th metatarsal is angled or bowed away from the foot, a procedure to return it to a correct position is required. During this surgery, the bone is cut and moved in such a way that the normal position is restored, and screws or wires are used to hold the bone down so the cut end can heal. Recovery takes six weeks on average, usually while in a walking boot, although some surgeons may prefer a cast in certain cases. Both these surgeries tend to be quite successful, and have low rates of significant complications.

While not as well known as a traditional bunion, a Tailor's bunion is nonetheless just as common, and can be just as painful. As one can see from this article, treatment options for this condition are available and can provide long lasting relief. It is yet another example of a foot condition that does not need to be suffered through for a lifetime.

The Cause, Symptoms, and Treatment of the Tailor's Bunion

Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit the website of this Indianapolis foot doctor for more articles.

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