S05E78 The Inside Scoop on Safe and Effective Fat Dissolving Treatments

Unlock the truth about fat-dissolving treatments as we sit down with cosmetic experts Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic. This episode cuts through the hype and gets to the heart of both FDA-approved and unapproved fat melters. With a recent FDA bulletin raising alarm over serious complications from non-approved products, we delve into the safety, efficacy, and real-world results of these treatments. If you've ever considered cosmetic procedures to target stubborn fat, particularly under the chin, this conversation is your essential guide to making informed decisions that prioritize your health and satisfaction.

Amidst a sea of cosmetic options, it's crucial to separate fact from fiction, and we provide the real scoop on Kybella, contrasting it with the more traditional micro liposuction. Also we discuss why patients are increasingly savvy about their choices, often opting for surgical interventions over injectables for quicker, more reliable results. Whether you're a patient weighing your options or a professional keeping abreast of the latest developments in cosmetic treatments, this episode arms you with the insights to navigate the evolving landscape with confidence.

Dr. Sam Jejurikar @samjejurikar @3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic 3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S05E78 The Inside Scoop on Safe and Effective Fat Dissolving Treatments

Transcript

[00:00:00] Dr. Lawrence Tong: hi everyone, I'm Dr. Larry Tong. I am one of the hosts, guest hosts actually, today on the podcast. I'm joined with Dr. Sam Rhee, uh, from, uh, New Jersey, and, uh, Dr. Sal Pacella from San Diego. Thanks, and great seeing you guys again.

[00:00:25] Dr. Salvatore Pacella: Dr. Chong, how are ya?

[00:00:26] Dr. Sam Rhee: Very good.

[00:00:28] Dr. Salvatore Pacella: Neighbor to the north. Love it.

[00:00:31] Dr. Lawrence Tong: So today we have an interesting topic. Um, recently the FDA put out a bulletin warning against, um, unapproved, FDA unapproved fat dissolvers. Now, there is, um, a FDA approved, uh, fat dissolver, which has, uh, been, uh, uh, uh, Um, employed for melting fat under, uh, under the chin area. Um, in the States, it's Kybella.

The, uh, same drug is used in Canada. It's called, uh, Belchira. And, uh, that has approval. But, uh, the warning from the FDA was that, um, there have been, uh, products being sold online or either used in, uh, med spas or similar type clinics which use, uh, Chemicals that melt fat, but these are not FDA approved products.

And the reason why the warning has come out. is because there have been, um, bad complications related to the use of these, uh, products. So, um, I'll start off with, um,

[00:01:35] Dr. Salvatore Pacella: How about we start off with our disclaimer? We

[00:01:37] Dr. Lawrence Tong: yes, sorry about that.

[00:01:39] Dr. Salvatore Pacella: All right. This show is not a substitute for professional medical advice, diagnosis, or treatment, particularly when it comes to fat dissolving agents. This show is for informational purposes only. Treatment and results may vary based on the circumstances, situation, and medical judgment after appropriate discussion.

Always seek the advice of your surgeon or other. Qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delays seeking advice because of something in the ship.

[00:02:04] Dr. Lawrence Tong: All right, great. So I'll start off with, um, either of you, what, um, experience do you have with fat dissolvers and how do you feel, um, about their effectiveness and how patients, um, you know, are happy or unhappy with, uh, the results?

[00:02:23] Dr. Sam Rhee: Uh, I've used Kybella, and I will say I'm not a huge fan, uh, in general. It was really hot when it first came out. Um, I, it took me a while to actually get my hands on it, because I wasn't a Platinum provider or whatever it is that the, you know, they rank providers in terms of volume of injectables that you use.

And I don't do a ton of injectables. So once I got it, I, I did it on, um, some family members who really heard about it, really wanted it. Um, like, uh, um, not, uh, like my, uh, brother in law and, um, he did not like it, uh, it, the Kybella required like three treatments. Uh, spaced out over about six to eight weeks each, and there was a tremendous amount of swelling every time he got it, and it worked, but it didn't work, uh, 100%.

I would say he probably got maybe like a 50 percent reduction in, in terms of his fullness under the, under the chin. And so he didn't think it was really worth it, uh, which was the same thing with some of the patients. Um, I had tried, some of them got good results, but a lot of them got mediocre to average results and they felt like the discomfort and the swelling from the chin swelling underneath where the injections were, which were not comfortable injections either, um, was not, was not great.

And for me as a surgeon, I always felt like, you know, liposuction got me a. Uh, a better result, a faster result, uh, less discomfort, uh, so in general, if someone really wants Kybella, I don't, I won't say no, but I think most patients are savvy enough these days in 2024 to ask for liposuction under the chin, especially for younger patients.

And uh, they'd rather not go for the fat dissolving products as much these days. For me, I don't know.

[00:04:27] Dr. Salvatore Pacella: Yeah, I agree, uh, with Sam. I think it was, uh, it was marketed very heavily on its, uh, release and, um, I think like anything it's, it rides the wave of, uh, satisfaction afterwards. So I agree. I've used it a couple times. I haven't been overly impressed, I think, in my hands. For a tiny little bit under the chin, I can do a little bit of micro liposuction in the office setting.

Um, not put people to sleep. It's a minimal cost. And in fact, by the time you've paid for three Kybella treatments, you've probably paid for definitive liposuction underneath the chin anyway. And so, um, I think it's, uh, we should approach this with caution because You know, keep in mind the, the, um, the market for med spas.

is not necessarily the market for plastic surgeons. You know, us three as plastic surgeons, we have the benefit of, of elevating the next step of care, right? If something doesn't work, we can always try something more invasive. Whereas, if you're seeing a nurse practitioner in a spa or some sub, Some other provider, they, they're, they're only limited by what they can do from an injectable or, um, or a laser or something standpoint, right?

So, so because, because you have one arrow in your quiver, you're going to use that arrow, right? And not go to others. So, so,

[00:05:55] Dr. Lawrence Tong: Yeah, I, I 100% I agree with both of you. I think that the issue with Kybella, um, is that you inject it, you don't really have control over, it's going to get dissolved or removed. Um, and because it's a, you know, it's a drug that you're injecting, I'm sure that they formulated it in a way which Uh, it sits more on the conservative side of things.

They're not going to give something so strong that it's going to melt a bunch of the fat and you're going to look skeletonized. Um, and it's true, the, the, uh, the amount of swelling and discomfort that they get from it is actually more than what I would see in a patient where I do liposuction to the submental region. And on top of that, the areas that you're allowed to inject that's recommended is much more limited than what you can do with liposuction. So, if there's a certain area that the patient wants, um, more attention to, you might not necessarily be able to get, you know, get to that area. So, for all those reasons, I think that Uh, the fat dissolving has its place maybe in somebody who's not willing, cannot do surgery for, for whatever reason.

And they're okay with maybe getting a result that's, um, more on the subtle side when you're comparing it to, um, to liposuction. Now, can any of you comment? Yeah, go ahead.

[00:07:24] Dr. Salvatore Pacella: other thing I wanted to say too is, you know, we've, as plastic surgeons, we've learned this lesson for the last 30 years with another product that people use. Uh, an off the shelf product that people use to melt fat, and that's steroid injection, right? And so when you've had, when you've had little areas of fat collection, or say, overdone fat transfer, um, you know, surgeons have injected steroid in the past to, to melt that fat.

And, and I've seen devastating consequences from that, really cavitation, open wounds, um, you know, thinning of skin. Um, it's just a, it's a disaster. Um, and so, you know, we, we just really have to, I think, understand that some things work, some things may work, but are very unpredictable. So you want to balance the certainty versus the invasiveness versus the risk, you know.

[00:08:19] Dr. Lawrence Tong: uh, Dr. Rhee, uh, you want to comment on Um, the use of sort of non approved chemicals for melting fat.

[00:08:29] Dr. Sam Rhee: Yeah. So this was an FDA warning, as you mentioned, and then the news outlets have picked this up, how there are these non FDA approved fat dissolving injections, and they go under the name, uh, of like Aqualix, Lipo Dissolve, Lipo Lab, Cabeline, and they claim that you can inject these fat dissolving. in, uh, chemicals and reduce fat in the chin or the back or the thighs or upper arms or stomach.

And they have posted pictures of these horrible blisters and ulcers and scars on these patients who had these treatments and are permanently disfigured. They've mentioned. Serious infections, skin deformity, cysts, deep knots after receiving these injections. They've gotten them at clinics or medispas. Um, it's not clear whether these people who are injecting these chemicals are licensed in any way or, or certified by any real medical body.

And, uh, some consumers actually have bought these, uh, products themselves and self injected them themselves with even pretty similarly horrifying results. Um, I haven't seen any patients in my office with these problems. Um, I was wondering what you guys thought in terms of Seeing this type of thing in your area,

[00:10:03] Dr. Salvatore Pacella: Yeah, I haven't really encountered any of these rogue products necessarily. Um, however, um, or I should say people naming these by name. Um, but I have seen, you know, a lot of stuff injected that's coming from over south of the border, you know, and in Latin America. And with. Modest to devastating consequences.

I mean, it wouldn't surprise me if people are injecting Drano underneath their skin, you know, to, to lose fat. I mean, it's, it's, it's that aggressive sometimes.

[00:10:41] Dr. Lawrence Tong: So I, I've seen, um, similar types of situations. Not south of the border, but from the homeland. That's called the People's Republic of China. And, uh, you know, we've seen, you, you know, I asked the patients. No, the patients generally don't know. What's been done and they just have all these scars and disfigurement there.

So I think, you know, for our viewers, um, be careful about what you get injected, you know, make sure you do a little bit of research in general. I do not believe that there are any FDA approved, um, injectable products, um, that have been approved for use in the body, uh, except under, under the chin. Even if they do work, you can't expect them to be a substitute for, you know, something like liposuction. Uh, so I don't, the problem is that there's no control over these, um, areas once, once the stuff gets injected. Uh, even if it did work, how, how would you know how to inject it so that you would get a nice, even result?

I just see, you know, all kinds of problems with trying to inject. Some sort of liquid or chemical, uh, for, for the sake of.

[00:12:10] Dr. Sam Rhee: I, you know, it's, this is not new in the sense, like you said, we've seen over decades, people getting all sorts of stuff injected to melt fat for a while. It was herbal extracts that we, that I saw, um, people have injected free silicone for a long time for many, many, many years for as fillers, uh, into their body, into their butt.

Um, don't quite understand why people feel it's okay to do so, other than the fact that, um, they don't want to spend a lot of money, or they can't spend a lot of money, and they are desperate, and I can understand a patient who is really unhappy with their appearance. Somebody promises them something that's too good to be true and they give it a shot.

But this is not like buying a slap chop where, you know, you get it in the mail and you're like, damn, this thing doesn't work. Like this is your body. And I think every so often we just have to remind people. that it's not just that it might not work, that it could seriously disfigure your body. One of the case reports they had was that it wasn't that it just didn't work, like they got a mycobacterium infection.

And as you guys know, mycobacterium is the same type of infection that results in tuberculosis. It's really difficult to eradicate. that type of infection. It takes months and months and months of antibiotics. Um, it festers. It's really difficult to treat. And so, it's not just like, oh, well, I might just get some scarring or maybe it might not work.

No, this could really result in some serious, uh, consequences. And so, If you know of anyone who might be tempted to do something like this, um, where there are locations or people that offer this sort of stuff, um, definitely don't, don't even think about it for, for a second. I, I know that a lot of us really want to work on our appearance, work on our, on our bodies.

But, you know, this is something where they are really taking advantage of people. And it's unfortunate because, uh, I haven't dealt with this type of injection, but I have helped patients after other types of injections in the past. And it's just a really long, unfortunate process. And these patients are so sorry afterwards.

Um, and just a moment of poor judgment. can result in months and years of managing complications, which, which is so unfortunate. I, I don't know if you guys have seen any, uh, other specific, uh, cases where you've had to deal with just really, really bad consequences with these types of treatments.

[00:15:12] Dr. Lawrence Tong: Well, I mean, um, butt injections with, you know, silicone and all kinds of weird stuff, um, used to be a bigger problem. I think it's been publicized enough that, um, know, there's been several deaths that have been reported. And so I think consumers are a little bit wiser now. You know, uh, they're not going in, meeting somebody in the hotel room and getting their, Butts injected now. Just because you might be doing this in some sort of clinic, uh, and there's some veneer of legitimacy to it, um, you know, you just have to be careful whenever you're choosing any type of, you know, these are medical procedures, basically, um, that, you know, you, buyers have to be, uh, beware, and You know, do at least some due diligence, um, and it's, it's a shame that, you know, some places offer these things without, you know, looking fully at what are the safety implications.

[00:16:23] Dr. Sam Rhee: What do you think about, um, do you think that this will be less common once Ozempic and some of these other weight loss medications start to come, become less expensive and become more widespread, uh, that people might. not feel like they need fat dissolving injections and other, uh, other types of medications like this, uh, in the future.

Like I'm kind of

[00:16:48] Dr. Salvatore Pacella: I mean, I, I think, I think it might actually get worse because, you know, when, when you have, um, you know, Ozempic and Mugovi and all these things, you know, it, it generally reduces, or generally, um, allows you to lose weight centrally, but, you know, we know from weight loss, you can't spot reduce places, right?

So, like. There's still fat around your knees, your elbows, your neck. And so, um, you know, if anything, I think it might be, it might get worse and more noticeable, you know,

[00:17:20] Dr. Lawrence Tong: Yeah, I'm not, yeah, that's a good point. I, I guess we'll just have to see, you know, I guess the patterns of weight loss in people. Different according to each individual, and I would say that probably in some patients it will reduce their specific need for liposuction. But as Dr. Pacella said, maybe it's going to make things worse for others, so it might increase the demand for spot fat reduction.

[00:17:54] Dr. Sam Rhee: Well, I really appreciate your guys perspective on this. Hopefully we won't be seeing very many patients with this kind of problem. But, uh, if anyone out there does know of anyone, please let us know. We'd like to hear from you. Um, this is something that I think should be publicized more so that people are aware of what they might potentially be getting into.

Any other thoughts about these fat dissolving, uh, SPA, quote, SPA treatments, guys?

[00:18:24] Dr. Salvatore Pacella: be careful what you wish for.

[00:18:30] Dr. Lawrence Tong: All right. Well, I think Go ahead, Sam.

[00:18:34] Dr. Sam Rhee: No, that's it. Good points. Very, very good points.

[00:18:36] Dr. Lawrence Tong: So thank you, Sam and Sal, and to all our viewers. Uh, hope you've enjoyed this episode, and we look forward to speaking you, uh, speaking with you again in the future.