For injection lipolysis, we inject a mixture of deoxycholic acid and phosphatidylcholine directly into the fat deposit to be treated. Deoxycholic acid initiates the process of lipolysis in the body. This means that the cell membranes of the fat cells partially dissolve. The individual components are then transported away by the body via the lymphatic system and the liver. The circumference in the treated area decreases. Once the fat cells have been removed at the treated sites, they do not return.

Injection lipolysis is used precisely in those cases where disciplined exercise and a conscious diet do not achieve the desired result. In other words, it can be used on areas where stubborn fat deposits remain despite weight-loss measures.

Suitable treatment areas include:

• Chin / neck
• Upper arms
• Armpits and back (bra rolls, back fat)
• Upper and lower abdomen
• Waist and hips (love handles)
• Inner and outer thighs
• Buttocks
• Knees
• Ankles

Injection lipolysis is used particularly frequently on the abdomen and to reduce a double chin.

Many of our patients are bothered by fat deposits and small rolls of fat that are more pronounced in some areas of the body than in others and can be particularly stubborn.

This means that problem areas such as the chin, armpits, back, waist or abdomen may contain an increased number of fat cells. This is often genetically determined. Exercise or dieting can reduce or increase the contents of the fat cells, but not their number. As a result, for example, rolls of fat may remain around the waist even in an otherwise slim person. These fat cells can only be reduced with specific treatments such as injection lipolysis.

The treatment is suitable for women and men who are bothered by stubborn fat deposits in specific areas of the body. The aim is not weight loss, but the creation of more harmonious proportions. Typical patients are slim and active and would like to give their body more contour. The treatment is therefore not suitable for people with a BMI above 30, i.e. obesity.

Injection lipolysis must not be performed during pregnancy or breastfeeding, in patients with diabetes or in the case of an allergy to the ingredients. It should also not be carried out in patients with serious illnesses. We do not treat minors.

The result is not visible immediately, but develops gradually. The effect begins after around 14 days. Clear results can usually be seen between the fourth and sixth week.

As a rule, three to four treatments are required to achieve the desired result; in rare cases, more sessions may be necessary. The interval between treatments should be around four to six weeks.

• Phosphatidylcholine (PPC)
  Phosphatidylcholine is a natural substance. It is an extract from soybeans, more precisely a lecithin, and is also a natural component of animal and plant cells. In humans, it is an important component of bile and helps the body process dietary fat. In medicine, the substance has been used successfully, for example, to treat fat deposits in blood vessels. PPC has also been used in aesthetic medicine for many years. It binds body fat and, as part of injection lipolysis, contributes over the following weeks to a lasting reduction of fat and fat cells in the treated area.
• Deoxycholic acid (DCA)
  Deoxycholic acid is a secondary bile acid. It is formed from cholesterol in the liver and through the activity of certain intestinal bacteria via several conversion processes. As a bile acid, DCA has an important function in fat digestion. The sodium salt it contains, sodium deoxycholate, causes the fat-cell membranes to break down. In other words, deoxycholic acid dissolves the membranes of the fat cells and releases their degradable components, including glycerol and free fatty acids.

Phosphatidylcholine (PPC) and deoxycholic acid (DCA) have a synergistic effect, meaning that they support one another. Their interaction can be described as follows:

• DCA breaks open the fat-cell membrane so that fat and cytoplasm, the basic substance of the cell, are released.
• This process triggers an immediate inflammatory reaction, which is part of the intended treatment response.
• PPC then emulsifies the released fat and helps process it.
• The fatty acids are broken down biochemically via beta-oxidation, transported to the liver and metabolised there.

There are only a few nerve fibres in the subcutaneous fatty tissue, so the needle punctures usually cause little pain. During and after the injection, however, you may notice a mild burning sensation because of the pH value and the inflammatory reaction that begins in the tissue. If desired, we can apply a numbing cream beforehand.

After treatment, mild to moderate swelling in the treated area may persist for several days. A slight redness at first is also normal. Even though we use very fine needles (30G or smaller), small bruises can occur. These temporary effects should usually have subsided after seven to ten days at the latest.

Some patients experience itching, redness, pressure or swelling at the injection site after treatment. Bruising can also occur. These effects normally disappear within a short period of time, usually within a few days. Infections are very rare, as are irregularities or a reduced treatment effect. Injection lipolysis has already been performed many thousands of times, and serious permanent side effects are currently not known.

The treatment must not be performed if you have blood-clotting disorders, allergies to soy products, liver disease, cardiovascular disease or other serious internal medical conditions. Injection lipolysis must also not be used during pregnancy.

Neither injection lipolysis nor liposuction or other measures intended to create a harmonious body silhouette (Body Contouring) are suitable for weight loss. Both approaches nevertheless pursue a similar objective: reducing the number of fat cells and thereby reducing localised fat deposits.

Liposuction is appropriate when larger fat deposits are to be removed. It is a surgical procedure and therefore involves the usual surgical risks, such as anaesthesia, wound-healing problems and scarring, as well as a period of recovery. The costs are also higher.

For comparatively small fat deposits, injection lipolysis can be a suitable option. The treatment risks and costs are lower and there is no downtime, although the effect develops gradually rather than immediately.

Self-treatment is strongly discouraged. Even though the active substance itself can be used safely in the appropriate setting, it should only be administered by a physician.

For both safety and treatment success, it is essential to choose the correct dose, inject into the correct tissue layer and use the appropriate injection technique. The skin, a tendon, a muscle or connective tissue must not be injected accidentally. This requires detailed knowledge of the anatomical structures and should therefore only be carried out by a qualified medical professional.

Once fat cells have been destroyed or removed, they do not grow back. This makes it possible to reduce stubborn excess fat cells in areas affected by an unfavourable distribution of fat. If you keep your body weight reasonably stable, you can benefit from a long-lasting result.

To support the results of injection lipolysis in our Munich practice, we recommend the following:

• Your body removes the treated fat-cell components via the lymphatic system and the liver. Drink plenty of fluids, but no alcohol, to support these processes and your metabolism.
• Avoid saunas and solariums for two to three days after treatment.
• Do not have massages during this initial period. After three days, manual lymphatic drainage or gentle tissue massage can be supportive.
• Avoid exercise during the first few days. After around three to four days, you can become active again. Increased movement with a good oxygen supply can be beneficial.

The cost of treatment depends on several factors, including the number and size of the areas to be treated, the amount of active substance required and the training and experience of the physician.

It is always advisable to choose a qualified and well-trained doctor with appropriate expertise. A cost estimate should be preceded by a detailed consultation in which individual questions, concerns and possible limitations of the treatment are discussed. At our private practice for dermatology and aesthetics in Munich, one session of injection lipolysis costs between €300 and €500.

The active substance was discovered in Odessa, Ukraine, in 1959 and was used, for example, in the treatment of fat embolisms and to lower blood lipid levels. In 1988, Italian physicians used it for the first time to treat cholesterol deposits on the eyelids, known as xanthelasma. Treatment of under-eye bags followed in 1995.

Dr Hasengschwandtner investigated the substance again in 2001/2002 and developed its use further. Around the same time, the Brazilian physician Dr Patricia Rittes began using it to treat aesthetically bothersome localised fat deposits. Because this proved effective, the method of injection lipolysis has since become established in aesthetic medicine.