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Fat-dissolving injections are increasingly becoming popular in cosmetic injectables, but why?
Many men and women consider local deposits of fatty tissue unattractive and therefore unacceptable cosmetically. A negative impact on appearance can contribute to reduced self-esteem and insecurity. A raising popular Aesthetic treatment for this is lipolysis injections also known as “fat dissolving injections”. This non-invasive method for fat reduction is highly advantageous over surgical reductions which have serious risks associated with it, therefore non-surgical methods would have important clinical benefits.
Clinical studies provide evidence-based data to suggest that deoxycholic acid injections provide significant clinical benefits, such as a generally safe and free of complication method for fat reduction (Mokosch,2012). The active ingredient Deoxycholic Acid (DC) is present in the human body and is a secondary bile acid that is produced by the liver and used to break up fat for intestinal absorption.
Fat-dissolving injections are deemed as medical devices regulated by the Medicines and Healthcare products Regulatory Agency (MHRA). Currently, medical devices placed on the UK market must have a UKCA or CE marking, which symbolises the manufacturer's claim that the product meets all the general safety and performance requirements. It is unknown exactly how many fat dissolving injections are registered as medical devices. However, some popular brands known on the market are Aqualyx, Belkyra, and Desoface, although we know there are many other fat-dissolving injectable brands available.
Like any aesthetic procedure, there come risks and complications and as medical practitioners the more we know and understand the more we can safety net and risk assessment to reduce these risks and complications.
With any injectable treatment comes the risk of infection, below is a case study discussing localized infection post-fat-dissolving injectable treatment.
A 38-year-old woman presented to ED with, ‘spots on abdomen’. This lady has no previous medical history, not taking any medications prescribed or over the counter, and has no known drug allergies. On consultation, the patient declared she had fat dissolving injections into her lower abdomen 18 days ago and has subsequently developed several hard abscesses. On abdominal examination, the patient had 4 erythematous, swollen lumps. On palpation, firm masses, hot and tender to touch with no pustule heads visible. The patient’s vital signs were all within normal parameters and she appeared systemically well.
The patient reported to have been given ‘Aqualyx’ brand of fat-dissolving injection and further disclosed that she had been to see a beautician with no medical background for this treatment.
The patient was diagnosed with abdominal abscesses post fat dissolving injections. Abscesses typically form when bacteria enter the skin, as more bacteria multiply the body naturally forms a wall around the area to stop the bacteria from spreading to other parts of the body. As the bacteria multiply in the pocket it becomes more swollen and more painful. Ordinarily, this patient would have been referred to the surgical team for management, however, due to the Covid-19 pandemic and the UK being in a national lockdown, operating theatres were only operating for life-threatening conditions, therefore surgical options were, unfortunately, unavailable to the patient at this point in time.
As the patient was systemically well and vital signs stable, the patient has discharged on Flucloxacillin 500mg QDS 7/7 as per local trust antimicrobial prescribing policy to cover gram-positive bacteria. The patient was further advised to apply heat and to observe good personal hygiene.
Robust safety netting advice was given prior to discharge and advised to return to ED should any red flags arise.
Due to lockdown restraints, the patient was seen in the clinic 14 months post initial consultation in ED.
The patient reports in retrospect that after the initial prescription of flucloxacillin the lumps started to form pustule heads. After applying warm compresses every 2-4 hours around day 31 the lumps had started to burst, which heightened around day 63.
The patient managed the wounds and dressings herself with things she had brought from the counter in pharmacies.
The patient further reported by day 72-110 the lumps had softened and became less painful and were oozing a little exudate now. Managing horrendous complications such as this in a national lockdown is not an easy task.
Although this patient would have benefited hugely from surgical intervention, the patient’s own self-management of the infection was successful although with sub-optimal results, luckily the patient did not suffer further from systemic illnesses. It can be assumed that the infection healed with fibrosis and now lifelong scaring. The scars seen at 16 months (fig 2) will likely remain for life.
Research suggests that DC is a safe solution for the treatment of localized pockets of fat and many brands have gained FDA and CE approval, however, this case study corroborates the notion that regulating DC in the United Kingdom is imperative.
Healthxchange pharmacy is the authorized supplier by the manufacturer of Aqualyx in the UK. During the summer of 2019, the pharmacy released a statement indicating their concern for unlawful supply of Aqualyx to non-medical practitioners but also the manner in which it is imported into the UK.
The statement reports the high risk of the counterfeit product as they clarify they have encountered packaging being made available on the UK market which looks very similar to the original. Healthxchange continues to explain, that Aqualyx is an unlicensed medication, and those only correctly qualified and trained are permitted to administer it.
This patient is among a soaring number of other patients reporting complications after fat dissolving injections.
With the confirmation of counterfeit products readily available in the UK it is highly concerning as the risk to the general public is alarming.
As medical practitioners, we have a duty of care to our patients and the public.
It is our duty to create an awareness of Aesthetic procedure complications as this forms part of our consenting process but also we have an ethical obligation to report the misuse of medicines regarding supply or unsuitable practitioners carrying out treatments.
All referrals and complaints about potential breaches of medicines are reviewed and dealt with by the MHRA. The more breaches that are reported the more data is collected and in turn, risk assessments can be carried out and regulations can be implemented.
The scope of this case study does not cover as far as regulating every Aesthetic injectable and practitioner, further discussion of this would be hugely beneficial. Further discussion around regulating fat dissolving injections as cometic or medical devices would also prove advantageous, as it is evident these injectable treatments can cause a significant level of harm to the general public.
Conflict of interest statement
Conflict of interest Authors do not report any financial or personal connections with other persons or organisations, which might negatively affect the contents of this case study and/or claim authorship rights to this case study.
Mokosch A, Mota R, Gerber PA, Homey B. Schwere toxische Dermatitis nach Injektionslipolyse [Severe toxic dermatitis after injection lipolysis]. Hautarzt. 2012 Apr;63(4):282-4. German. doi: 10.1007/s00105-012-2359-2. PMID: 22418769.
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