Karyn Brown, a registered nurse at Parkcrest Plastic Surgery in Creve Coeur, wanted to lose a few nagging pouches on her body. She's in good shape, but those pouches wouldn't go away.
It probably didn't help being a staff member in a plastic-surgery medical practice where she was surrounded by people with flat stomachs and tiny waists. But she didn't want surgery: "Who wants the downtime? You have to be able to work."
Still, the diligence about her fitness couldn't overcome genetics.
"I, like every other woman you know, have body parts you try to hide, camouflage or wish weren't there," she says. "As you age, your body does change, and despite working out and being as fit as you can, genetics play a role and your body accumulates fat in certain areas."
The staff at Parkcrest had been looking at a treatment called Lipodissolve. It involves injecting a substance beneath the skin to get rid of small pockets of fat.
"It looked easy enough to do, and I had areas I wanted done," Brown says.
The practice started offering the treatment, and she jumped in line.
Are the treatments working?
"Yes, yes, yes, yes. I've had four treatments on my stomach, and it's really shrinking," she said. "It's something to get excited about."
Lipodissolve is becoming increasingly popular. Those who offer it say it's here to stay.
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. Six to 12 weeks after the doctor injects the drug the fat dissolves, and the trouble spot is gone.
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.
It's promising to become big news for Americans preoccupied with looking good.
"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 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."
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.
Parkcrest Plastic Surgery started offering Lipodissolve treatments this year after watching other doctors use it for two years.
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.
The major components for Lipodissolve are made of two substances:
_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.
_Deoxycholate, which is "bile acid," a solvent that the liver secretes to break up fat that enters your small intestine.