Lipodissolve is the trade name given to a process called injection lipolysis - doctor-speak for getting rid of body fat by injecting a chemical under the skin and over fat cells.

Lipodissolve is designed to remove small, stubborn pockets of fat that refuse to disappear with exercise and diet. It's not a cure for obesity. People with a high body mass index are not candidates for the procedure.

"People are crazy for anything that's new and minimally invasive," said Dr. Christian Prada, a plastic surgeon and assistant professor with St. Louis University School of Medicine.

Still, Prada and some other cosmetic-medicine doctors say they're not ready to embrace it yet, because all of the good news comes from reports by physicians, and not science by researchers.

The compounds used for Lipodissolve have not been approved or intensely tested by the U.S. Food and Drug Administration for any sort of fat reduction.

That means it's off-label use. Off-label means that it has been approved by the FDA for one purpose, but doctors are using it for a different purpose.

Off-label use of drugs is common, however. The medical community has a history of such medication use if the off-label treatment is similar to the approved treatment.

Using Botox to remove facial wrinkles, for example, is an off-label treatment. Botox is approved to relieve muscle spasms due to neurological problems.

While off-label use of a drug is legal unless specifically banned by the FDA, it accounts for the reluctance by many area cosmetic practitioners to use Lipodissolve.

"There's no FDA-approved use for (the compounds used in Lipodissolve), and there are no large studies to support its use," Prada said. "There are no studies to show the (long-term) side effects."

Local doctors agree that no American studies based on American standards exist. The only validation for Lipodissolve's use comes from Europe, where it has been used for years, and from the experience of doctors who have used it in the United States for the past several years.

"We just don't know," said Dr. Thomas Francel, chief of plastic surgery at St. John's Mercy Medical Center. Francel is considering offering the process in his practice and plans to take training. But he says he is hesitant. "I just haven't seen any science behind it."

Currently, the vast majority of doctors across the country offering the treatment appear to be internists and gynecologists who have taken training and watched other doctors perform the procedure.

Dr. Ronald J. Chod, owner of Aeterna Medical Spa, says he held back from offering Lipodissolve treatments until three respected physicians published a study in the Aesthetic Surgery Journal. The study showed the procedure was safe and set parameters for treatment, Chod said.

He and Aeterna's investors and directors decided to offer the procedure after that, he said. The practice includes dermatologists, he said. Chod and one other dermatologist oversee the procedure.

- Phosphatidylcholine, which occurs naturally in the body as a component of cell membranes. It's also sold as a food supplement called lecithin. Lecithin shows up in egg yolks, soybeans, fish and other foods. The form used for Lipodissolve is mainly extracted from soybeans.

The doctor uses a needle about the size of one used for insulin injections. A treatment consists of several small injections that surround the fat. The doctor determines the amount of compound needed to be injected. The American Society of Aesthetic Lipodissolve set the standard as a maximum of 100 milliliters, the equivalent of a little less than three fluid ounces.

In the first two or three days, patients may feel pain and heat sensation in the area, which may redden or bruise. The tissue beneath the skin hardens; it may feel like there are small cysts about the size of a marble in the area.

The fat cells actually grow for about a week after the injections, so those bumps are the death throes of the cells, doctors say. Eventually, the fat cells dissolve and are flushed from the body, they say.

There are no broad-based, independent studies proving how the fat-dissolving process actually works; doctors say it occurs because the same thing happens when lecithin is used to dissolve fat blockages in the blood vessels.

After six to eight weeks - in rare cases, as many as 12 - the swelling recedes and the spot has reduced. You may need to return for additional injections, or one may be sufficient.

It only takes off a relatively small amount of fat at a time - one-half pound, on average. Most practitioners space treatments a week to two weeks apart. Two to four treatments is the average, but there can be more.

Blogs, chatrooms and unofficial Web sites tend to complain mainly about doctors who are rude and about getting no results after paying lots of money. (But there are plenty of reports of success, too). The Post-Dispatch could find no reports of complaints regarding any serious side effects.

One risk, says Dr. David Caplin, of Parkcrest Plastic Surgery, is that unqualified people may use the compound. He offers Lipodissolve treatments, but doesn't advertise them.

"My concern is that anybody with a license can buy this, anybody can inject it," he said. "You either have to know a lot about body contouring to know who to treat and who not to treat and be able to offer alternatives, or you have to learn it on the job.

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