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Sticking It to Fat?

By Sandra G. Boodman washingtonpost.com

In the age-old battle of woman vs. fat, an arsenal of weapons have been deployed: creams, pills, devices, surgery and now, just in time for bathing suit season, mesotherapy -- a cosmetic treatment that involves injections..

Developed in France in 1952, mesotherapy was introduced in the United States several years ago. It involves a series of relatively painless injections into fat deposits below the surface of the skin. Some doctors inject small amounts of aminophylline or isoproterenol, drugs approved to treat breathing problems, while others prefer phosphatidylcholine, a drug not approved in injectable form by the Food and Drug Administration. Some doctors also use artichoke extract or other herbs.

"A lot of people are looking for a relatively noninvasive procedure" that is an alternative to liposuction, said Robert M. Adrian, a Washington area dermatologist who is among a growing number of cosmetic physicians offering mesotherapy. Some of his patients, he said, have had "fantastic results" from treatment. But some doctors question whether mesotherapy is useful or benign.

New York dermatologist Debra Jaliman called it an "expensive procedure that doesn't have much medical validity." Some patients may be convinced it works because of the placebo effect, Jalliman said, or because "if you're paying $350 per week to get rid of your cellulite, you're more likely to pay attention to your diet and to exercise."

In an article published in the April 15 issue of the journal Plastic and Reconstructive Surgery, plastic surgeons who studied the treatment noted that there are few good studies of mesotherapy, that use of unapproved drugs is common and that complications, including infections, have been reported. New York plastic surgeon Alan Matarasso, co-author of the study, warns that patients should be wary of mesotherapy until more is known.

"There is a complete lack of standardization in this procedure," said Matarasso, an associate clinical professor of plastic surgery at Albert Einstein College of Medicine in New York. "With mesotherapy, there are so many unsubstantiated scientific claims."

Rod J. Rohrich, immediate past president of the American Society of Plastic Surgeons, was more emphatic.

"It is mind-boggling to think that a physician would inject patients -- or that patients would allow physicians to inject them -- with unknown, unproved substances based on hearsay and unsubstantiated clinical findings," he wrote in an editorial that accompanied the journal article. "Anything short of being on a diet, actually doing exercise or making any commitment to lifestyle changes always has a mystical appeal."

It's not clear how mesotherapy is supposed to work, but proponents say it may cause inflammation that results in the breakup of fat deposits, which are released into the bloodstream. Swelling and redness are common after treatments.

Treatments usually cost $250 to $750 for a session that lasts five to 10 minutes; most patients undergo three to 10 treatments, which are not covered by insurance. Some doctors say the results are permanent, while many say that periodic re-treatments are required.

Adrian said he was initially skeptical about mesotherapy, but after taking several courses in the procedure he was convinced it was safe and effective and began offering it three months ago. He said his office fields about 100 calls per week from patients interested in the treatment that Adrian advertises as a way to "lose inches in hours."

Dima Ali, one of the busiest mesotherapy practitioners in the Washington area, said she has treated about 1,000 patients in her Reston clinic. She calls the therapy "by far the most successful and progressive of all cellulite treatments available" and cites the experience of her patients as evidence that the treatment works.

The skepticism about mesotherapy, she said, reminds her of the reaction to Botox a decade ago, before it became one of the most widely used wrinkle-banishing treatments.

"We are doing controlled [studies of mesotherapy] right now," said Ali, who compares cellulite to "fat trapped in a jail cell behind steel bars" that is liberated by the injections. Like Adrian, Ali said she uses phosphatidylcholine, an injectable compound containing lecithin that is not approved for use in the United States. She also uses artichoke extract and collagenase, an enzyme that breaks down the protein collagen.

Lionel Bissoon, an osteopath who has helped popularize mesotherapy in the United States, said he has trained more than 140 physicians in the technique in three-day courses, for which he charges $5,000. Bissoon, who divides his time between clinics in Palm Beach, Los Angeles and New York, said he uses mesotherapy for more than 100 conditions, including the treatment of cellulite, migraines, back pain, acne and insomnia.

In Bissoon's view, the lack of standardization that critics decry reflects the multiplicity of approaches available to physicians treating any ailment.

"Is treating a cold a standard thing?" he asked, adding that physicians "have 300 antibiotics to choose from." (Medical experts note that colds are viruses and should not be treated with antibiotics, which are useless against colds.) Bissoon said he typically injects patients with aminophylline and isoproterenol, drugs used to improve breathing in patients with emphysema and other serious lung diseases.

Meostherapy is safe, he added, noting that there have been deaths from liposuction. "We have not killed anybody," he said, adding, "I think the plastic surgeons are looking at mesotherapy as invading their turf."

Jeanne Whyte, a 55-year-old executive from Falls Church, isn't troubled by the controversy. She was Adrian's first mesotheraphy patient and is delighted with the results of the two treatments on her chin intended to eradicate small fat deposits.

"I can't believe the difference," said Whyte, who has had other cosmetic treatments, including Botox. "This was a cakewalk. I'd love it for my stomach, but you'd need a gallon of it." ?

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