الفهرس 
Adipose tissueOnly 14 pages are availabe for public view
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Abstract
PPC, a soybean lecithin extract, and the main phospholipid component of the cell membrane, was originally developed as a treatment for fatty deposits in the cardiovascular system and the liver. Intralesional PPC injections were first presented in 1988 when Sergio Maggiory; an Italian doctor, reported his results at the 5th Mesotherapy Congress in Rome after injecting the substance PPC in xanthelasmas around the eyes. In 2002 Dr. Rittes from Brazil published her experiences using injections of PPC for infraorbital fat pads and other localized collections of fat.
Since then, multiple clinical trials supported the idea that subcutaneously injected PPC leads to a reduction in volume of adipose tissue.
Few histological studies that explain the mechanism of action of PPC have been published. One of them showed that injection lipolysis with PPC causes tissue fibrosis and necrosis of adipose and vascular tissues. Another study showed that fat reduction plus skin retraction was recorded in all subjects included in the study.
The aim of this study was to evaluate ten patients presenting with local fat deposits (upper outer thigh) after single session of injection lipolysis with PPC, by photographing, circumference measurement, as well as by histological examination pre-, one and two months after treatment. Histological sections were stained by routine H&E, Masson’s trichrome (for collagen fibers) and aldehyde fuchsin (for elastin fibers). Morphometric analysis of histological findings was done by image analyzer for precise assessment of changes following injection.
from examination and metric measurements at the end of the study, there was a statistically significant reduction of thigh circumference across the injected area with leathery tight skin texture.
Overall, following one month of treatment, the skin showed increased epidermal thickness, number and size of subepidermal capillaries which were congested with RBCs, with perivascular and periappedageal inflammatory infiltrate, and destruction of fat cells in the hypodermis. Dermal collagen was destroyed and replaced by cellular and tissue debris in some sections, however, elastic fibers appeared thick, tortuous and branching.
Following two months of injection, the epidermis showed increased thickness, and the dermis showed milder vascular and inflammatory reactions than that found after one month of injection. Fat cells started to regenerate in some cases, dermal collagen fibers increased and deposited in coarse bundles. In addition, elastic fibers appeared thick and tangled with abnormal elastotic material.
The results of image analysis showed increased epidermal thickness, increased collagen area percent, and increased elastin area percent at the end of the study, but the differences from pre- treatment values were not statistically significant.
Short-term self limited side effects included pain, stinging, erythema, itching and subcutaneous nodules.
Conclusion
In conclusion, single session PPC injection for localized fat deposit has temporary lipolytic effect, but with noticeable contouring effect due to regenerating effect on dermal collagen and elastin leading to skin tightening. This dual effect is very important as reduction of fat only leaves ugly redundant skin that may need resection. Sustained and further sculpting effect can be achieved provided that injection lipolysis sessions are combined with diet programming and regular physical exercise.
Recommendations
• Extended follow up after PPC injection; by histological assessment to find out the timing of disappearance of inflammatory and vascular responses, and hence proper spacing of sessions.
• Histological studying of the possible skin rejuvenating effect of smaller doses of PPC injection with minimal vascular and inflammatory responses.