Fat contouring has trended from invasive surgery to nonsurgical modalities, with 140,314 nonsurgical fat reduction procedures performed in 2020. [1][2][3] Existing minimally invasive treatments can entail high-cost equipment. Current radiofrequency, 4,5 high-intensity focused ultrasound, 6,7 cryolipolysis, 8,9 and laser lipolysis 10,11 medical devices range in cost from one to several tens of thousands of U.S. dollars. The cost of a laser source, which primarily makes up laser lipolysis devices, 12 can be upward of $1500. 13 In addition, deoxycholic acid, 14 as a nonregulated commercial product, can cost almost $500 for 100 mg of product. 15 To overcome such limitations, we have investigated a potential Background: Current minimally invasive fat reduction modalities use equipment that can cost thousands of U.S. dollars. Electrochemical lipolysis (ECLL), using low-cost battery and electrodes (approximately $10), creates acid/base within fat (width, approximately 3 mm), damaging adipocytes. Longitudinal effects of ECLL have not been studied. In this pilot study, the authors hypothesize that in vivo ECLL induces fat necrosis, decreases adipocyte number/viability, and forms lipid droplets. Methods: Two female Yorkshire pigs (50 to 60 kg) received ECLL. In pig 1, 10 sites received ECLL, and 10 sites were untreated. In pig 2, 12 sites received ECLL and 12 sites were untreated. For ECLL, two electrodes were inserted into dorsal subcutaneous fat and direct current was applied for 5 minutes. Adverse effects of excessive pain, bleeding, infection, and agitation were monitored. Histology, live-dead (calcein, Hoechst, ethidium homodimer-1), and morphology (Bodipy and Hoechst) assays were performed on day 0 and postprocedure days 1, 2, 7, 14 (pig 1 and pig 2), and 28 (pig 2). Average particle area, fluorescence signal areas, and adipocytes and lipid droplet numbers were compared. Results: No adverse effects occurred. Live-dead assays showed adipocyte death on the anode on days 0 to 7 and the cathode on days 1 to 2 (not significant). Bodipy showed significant adipocyte loss at all sites (P < 0.001) and lipid droplet formation at the cathode site on day 2 (P = 0.0046). Histology revealed fat necrosis with significant increases in average particle area at the anode and cathode sites by day 14 (+277.3% change compared with untreated, P < 0.0001; +143.4%, P < 0.0001) and day 28 (+498.6%, P < 0.0001; +354.5%, P < 0.0001).
Conclusions: In vivo ECLL induces fat necrosis in pigs. Further studies are needed to evaluate volumetric fat reduction. (Plast. Reconstr. Surg. 153: 334e, 2024.) Clinical Relevance Statement: In vivo ECLL induces adipocyte death and fat necrosis. ECLL has the potential to be utilized in body fat contouring.