Lipodissolve is back. Well, sort of. The medication that has been used successfully to kill fat cells on Lord knows how many people since the 1960’s has finally been officially okayed by the U.S. Government! The FDA has given the green light to a drug called Kybella. Kybella is approved for the treatment and elimination of the fat pockets that create double chins. Yay! Now we have an alternative to surgery for the treatment of chin fat.

Those of us who have been in the aesthetic industry for more than a decade will recall the lipodissolve craze. This practice involved use of a medication called lipostabil into subcutaneous fat. The medication acted like an acid and ate away the fatty tissue. When done right, it really worked. Of course, people got crazy and overdid it. Unscrupulous practitioners over treated and got the medication into the skin and muscle, causing those tissues to be “eaten away”. Some people were scarred or went in to kidney failure because of the high doses. The FDA put on the brakes and basically made it illegal to use lipostabil for destruction of fat in any dose which, though it may have been overkill, was definitely warranted at the time.

In the interim, a small pharmaceutical company by the name of Kythera took the idea of injectable fat destruction under its wing. They realized that lipostabil really did work and if a safe dose and protocol could be developed they could have a blockbuster medicine on their hands. They performed several painstakingly thorough studies and submitted their evidence to the FDA. Just as FDA approval was inniment, Kythera was purchased by Allergan (the botox people). Allergan will now get to legally market and sell a medication that kills fat cells when injected.

A double chin can really make you look older and overweight, even if you are not any of those things. A lot of us just genetically store some fat there, no matter how thin and fit we are. Prior to Kybella there were basically 2 things you could do to fix it. Your options were to have a face/neck lift or have liposuction. If you were not in the mood for a surgical fix, you were outta luck. That’s why people are excited about this medicine. It allows effective treatment of double chins in the office setting, not the operating room.

Kythera did a lot of work before Allergan bought them. They delineated the details behind the safe and effective use of  lipostabil. We all figured that lipostabil worked, but Kythera actually proved it so kudos to them. Dr. Patricia Rittes from Brazil was one of the first doctors to use lipostabil for cosmetic purposes, so kudos for her as well.

Now for the bad news: Kybella has a lot lower concentration of the active ingredients and the FDA has only approved small doses of it at each treatment session. This makes it very safe to use and really hard (and expensive) to misuse.   For small fat pockets, it is still effective. Since the studies were done on chin fat, this is currently the only area on which it can be used. It worked in over 70% of people, within 2 to 4 treatments, with minimal side effects and barely any complications. So it’s still pretty darn good!

Now for the science: Lipostabil is an old drug that is a combination of phosphatidylcholine (a component of the cell membrane) and deoxycholate. Deoxycholate is a bile salt that our liver makes to digest the dietary fats we ingest. The thinking was that PC, short for phospatidylcholine, helped get the DC, short for deoxycholate, past the cell membrane and into the fat cells. Lipostabil was initially used intravenously. After a trauma, if major bones are broken, fat from the bone marrow can get into the blood stream and cause a heart attack or stroke. Lipostabil was put in the IV to dissolve any fat emboli that may have been created. Dr. Rittes, in Brazil, had the brilliant idea to inject the stuff directly into fat under the skin and “lipodissolve” was born. It was the Americans who really finetuned it. In 2004, Dr. Adam Rotunda was an dermatology resident in California who took an interest in this treatment. He was one of the first researchers to discover that it really was the DC (deoxycholate) that was doing all the work, and maybe the PC was just causing unnecessary inflammation and irritation. He was publishing his findings when the FDA pulled the rug out from under us. Kythera picked it up from there and now we have Kybella, which is all DC with no PC.

Now for the future: Hopefully Kybella will pave the way for further studies on higher dosages and other treatment locations (Bra fat, anyone? Upper arms?). With more information and research we may find it helpful for under eye bags or saddle bags. Stay tuned, there is more to discover on this topic. I, for one, can’t wait!