Fat jabs- side-effects no one told you about

Heard about all the good stuff about fat jabs? Well, here's a reality check:

1. A patient from a small town in East Malaysia undergoing her 6th session of mesolipo injections went home but minutes later, she developed itchy rashes & difficulty breathing. Lucky for her, there is no traffic jam in a small town & her husband managed to get her to a hospital on time. She had almost stopped breathing when she arrived in the hospital. What she suffered was a severe anaphylactic reaction. (allergic reaction)

2. A lady whom a colleague treated suffered severe vomiting & diarrhea and became so weak she almost had to check into a hospital - probably a side-effect of too much caffeine in the fat jabs. My colleague almost pissed in the pants fearing exposure as the doctor who gave the caffeine overdose.

3. A lady had a large crater on her tummy as a result of the fat dissolving drugs dissolving away the skin on her tummy as well. (Some of you may remember the photo in the Star) One of the ingredients in fat melting cocktails is hyaluronidase, an enzyme that dissolves hyaluronic acid - a component of our skin. If injected too superficially, the skin gets dissolved away as well.Another popular ingredient, phosphatidylcholine, can also cause skin ulceration if injected too superficially. I think this lady needed extensive skin grafting to stay alive.

4. A lot of these "fat-melting compounds" are compounded medications (i.e. made up by independent pharmacists) which are generally not tested by independent regulatory
bodies and may potentially have inaccurate potencies or contaminants. Don't get distracted by the "made in USA" or "made in UK" sales pitch - the source & purity of the product is still unknown as the stuff is still made in small pharmacies & not pharmaceutical grade facilities.

5. Heat and long-term storage can decompose phosphatidylcholine into lysophosphatidylcholine, a toxic degradation product which is known to cause hepatic
cholestasis, enzyme elevation, and intravascular hemolysis i.e. it can cause liver failure & potentially kill you.
The phosphatidylcholine which is widely used in the market now are brought in illegally by runners. And yes, you're guessing right - a large proportion are hand carried in through customs, so you can imagine the storage conditions during its journey from USA or Europe to Malaysia.

(If you underwent mesolipo injections 4-5 years ago, it was much safer then because local drug suppliers were importing them openly & shipping & storage was definitely more reliable. Customs had no idea what to classify them & there was no open ban. Now, even Brazil has banned it because of rampant abuse)

Why am I highlighting this & stepping on the toes of my suppliers & fellow doctors? Because I've clearly stated before on many previous occasions that I am a strong supporter of mesolipo injections but I don't want any more problems highlighted in the press about it. If we allow more bad press on this matter, we are just allowing the Ministry of Health (which are governed by narrow-minded Western-trained doctors who conclude that a guy with obvious multiple massive bruises on the body caused by torture has died from myocarditis whilst in custody) more fodder to ban this very simple & lucrative cosmetic procedure.

As I've said in my other posts, I'll say it again - I'm not against fat jabs. In fact, I think it's a very promising way of targeted fat loss without the risks of surgery. What we need are strict guidelines about what drugs are safe to use, what dose, what mixture, where to inject, how far apart, etc to get the best benefit at the safest doses.
At the moment, suppliers of these fat melting drugs in Malaysia can't even tell us doctors the full list of ingredients in their pre-mixed cocktails because their suppliers won't tell them for fear of copycats. The Drug Control Authorities cannot approve medicines which have no safety record for a reason.
There are many ongoing trials in USA ascertaining safe limits of various fat melting drugs (conducted by pharmaceutical companies who will be seeking FDA approval) - reports due in 2010 or earlier. Isn't it worth waiting for it rather than to put your life on the line to lose a few bulges?

Nonsurgical facelifts - I'm confused!

There are many methods touted to perform nonsurgical facelifting but there are a few facts we have to clarify:

Firstly, surgical facelift (cutting surgery) usually entails cutting away excessive sagging skin & subsequently pulling up remaining skin in a gravity-defying move. This is a necessary procedure for those with excessive skin, however, this doesn't improve the quality (defined by amount of collagen & elastin, firmness) texture or volume of face.

Secondly, thread or ribbon lifts also give gravity-defying instant lifting effects but it also doesn't improve firmness, texture, hydration or volume of face. Pros: no scars. Cons: it usually doesn't last as long as claimed. Poorly done jobs may only last 2-3 months. Done well, perhaps 1.5 years at best.

So, what's on offer the non-surgical way?
Pro: no scars, improves firmness, texture, hydration & volume & skin tone/complexion.
Cons: not as good "lifting" compared to surgical methods. In fact, it's more a skin tightening effect, can't say lifting as it does not give gravity-defying effects.

I've divided it into 3 groups to make treatment selection easier.

1) Needle-phobic, no downtime (but also least effective wrt tightening, no effect on complexion)
- Cynosure Elite laser RM3000 for 6 sessions
- Radiofrequency RM3000 for 10 sessions

2) Needle-phobic, don't mind 1 week downtime each laser session
- fractional CO2 laser RM4000 for 5 sessions
NB: advantage of frac CO2 - also improves skin complexion (you get fairer & rids pigmentation)

3) Don't mind needles, minimal 1 day downtime
- Liquid facelift with combination Botox & Restylane filler (please see July writeup on liquid facelift) RM3500
- Needleabrasion + PRP (adv: injecting with your own plasma, nothing foreign. cons: does not treat dynamic wrinkles like Botox, so actually this is good complement to Botox). RM2000. If you add on Botox cost, total cost is approx RM2800.

Approx cost to give 1 year effect is given above.