Exploring feedback‐controlled versus open‐circuit electrochemical lipolysis in ex vivo and in vivo porcine fat: A feasibility study

Abstract

Objectives: Minimally invasive fat sculpting techniques are becoming more widespread with the development of office-based devices and therapies. Electrochemical lipolysis (ECLL) is a needle-based technology that uses direct current (DC) to electrolyze tissue water creating acid and base in situ. In turn, fat is saponified and adipocyte cell membrane lysis occurs. The electrolysis of water can be accomplished using a simple open-loop circuit (V-ECLL) or by incorporating a feedback control circuit using a potentiostat (P-ECLL). A potentiostat utilizes an operational amplifier with negative feedback to allow users to precisely control voltage at specific electrodes. To date, the variation between the two approaches has not been studied. The aim of this study was to assess current and charge transfer variation and lipolytic effect created by the two approaches in an in vivo porcine model. Methods: Charge transfer measurements from ex vivo V-ECLL and P-ECLL treated porcine skin and fat were recorded at −1 V P-ECLL, −2 V P-ECLL, −3 V P-ECLL, and −5 V V-ECLL each for 5 min to guide dosimetry parameters for in vivo studies. In follow-up in vivo studies, a sedated female Yorkshire pig was treated with both V-ECLL and P-ECLL across the dorsal surface over a range of dosimetry parameters, including −1.5 V P-ECLL, −2.5 V P-ECLL, −3.5 V P-ECLL, and 5 V V-ECLL each treated for 5 min. Serial biopsies were performed at baseline before treatment, 1, 2, 7, 14, and 28 days after treatment. Tissue was examined using fluorescence microscopy and histology to compare the effects of the two ECLL approaches. Results: Both V-ECLL and P-ECLL treatments induced in-vivo fat necrosis evident by adipocyte membrane lysis, adipocyte denuclearization, and an acute inflammatory response across a 28-day longitudinal study. However, −1.5 V P-ECLL produced a smaller spatial necrotic effect compared to 5 V V-ECLL. In addition, 5 V V-ECLL produced a comparable necrotic effect to that of −2.5 V and −3.5 V P-ECLL. Conclusions: V-ECLL and P-ECLL at the aforementioned dosimetry parameters both achieved fat necrosis by adipocyte membrane lysis and denuclearization. The −2.5 V and −3.5 V P-ECLL treatments created spatially similar fat necrotic effects when compared to the 5 V V-ECLL treatment. Quantitatively, total charge transfer between dosimetry parameters suggests that −2.5 V P-ECLL and 5 V V-ECLL produce comparable electrochemical reactions. Such findings suggest

In vivo electrochemical lipolysis of fat in a Yucatan pig model: A proof of concept study

“…As we have previously demonstrated, electrochemical lipolysis (ECLL) has the potential to be a novel and effective approach to selectively reducing body fat. [10][11][12] ECLL creates localized pH gradients through the formation of hydrogen ions at the anode and hydroxide ions at the cathode. This is achieved through water electrolysis via the reactions:…”

“…10 Our group has demonstrated that ECLL can be accomplished with either a simple open-loop voltagedriven system (V-ECLL) or a potential-driven feedback system (P-ECLL). 11 While V-ECLL is simple direct current (DC) system requiring only two electrodes, P-ECLL is based on the use of a potentiostat that incorporates the use of three electrodes: a working, counter, and reference electrode connected by an operational amplifier. 36 The reference electrode provides feedback control that allows for sufficient voltage at the counter electrode that sustains a designated potential at the working electrode.…”

“…36 Our previous ECLL investigations used extremely short needle electrodes (1 cm) inserted perpendicularly to the skin surface to obtain a tissue response analogous to a point spread function. 10,11 In this study, a more clinically relevant device was used, which incorporated the insertion of long needle electrodes parallel to the surface of the skin in the subcutaneous fat layer. This produced a trough-like depression in the skin weeks after therapy that is readily observed clinically.…”

Introduction to 2022 special dermatology/plastic surgery issue

“…Energy-Based Devices in Surgery and Medicine might be a clunky title for a journal, but multiple articles in this issue reflect the reality of a burgeoning literature in non-laser technology in addition to exciting advances in laser applications and combination therapies. Thermo-mechanical injury, 1 fractional radiofrequency (FRF), 2,3 acoustic subcision, 4 nanopulse stimulation, 5 and electrochemical lipolysis, 6 all make appearances.…”

“…It is a needle-based technology that uses direct current to electrolyze water creating acid and base in situ, ultimately leading to fat saponification and adipocyte cell membrane lysis. Heidari et al 6…”