A lipoma is a common, non-cancerous growth composed of mature fat cells, typically found just beneath the skin. These benign masses are generally slow-growing, soft, and easily movable when touched. They primarily present as a cosmetic concern or cause discomfort if they press on a nerve. Traditional open surgical excision involves cutting out the entire mass and its surrounding capsule. However, the demand for reduced scarring, faster recovery, and non-surgical options has led to the development of several new, less invasive alternatives.
Injection-Based Dissolution Therapies
Newer injection-based methods focus on chemical lipolysis, a process that breaks down fatty tissue directly within the lipoma without requiring an incision. Corticosteroid injections, often using a compound like triamcinolone acetonide, are one such approach. The corticosteroid is injected directly into the mass to induce localized fat atrophy, causing the lipoma to shrink over time. This high-concentration steroid causes reduced cellularity and an increase in fat cell death (apoptosis).
Studies show that corticosteroid injections can reduce the size of a lipoma by approximately 50 to 60%, with the greatest benefit seen in smaller masses. However, they rarely result in complete elimination, and the effect is not always permanent, sometimes leading to regrowth. Due to this limited long-term efficacy, these injections are frequently reserved for patients who prefer a non-surgical option or for small, symptomatic lesions.
A more direct fat-dissolving approach uses deoxycholic acid, a naturally occurring bile salt that the body uses to emulsify dietary fat. When injected, deoxycholic acid actively destroys the cell membranes of the fat cells—a process called adipocytolysis—leading to irreversible cell death. This compound is approved for the treatment of submental fat and is used off-label for lipoma dissolution.
The destroyed fat cells are naturally cleared by the body over several weeks. Achieving a significant reduction often requires a series of treatments, typically two to six sessions spaced four to eight weeks apart, depending on the size of the lipoma. Clinical reports have demonstrated a mean area reduction up to 75% in some cases, offering a scar-free alternative to surgical removal.
Advanced Minimally Invasive Removal
For patients requiring physical removal but wishing to avoid the lengthy scar of traditional surgery, advanced minimally invasive techniques offer a compromise between efficacy and cosmetic outcome. Liposuction-Assisted Lipoma Removal (LAR) is a technique that removes the fatty mass. This method involves inserting a thin tube, known as a cannula, through a very small incision placed adjacent to the lipoma.
The surgeon uses the cannula to mechanically break up the fatty tissue within the lipoma capsule and then aspirates the liquified fat. This process is advantageous for larger lipomas, allowing for the removal of substantial tissue volume through an incision often less than one centimeter in length. The technique significantly reduces post-operative scarring compared to open excision, resulting in a quicker recovery time and better cosmetic appearance.
Another technique is Minimal Incision Extraction (M.I.C.E.), sometimes referred to as the squeeze technique. This method involves making a small linear incision, often only one-third the diameter of the lipoma, directly over the mass. Through this tiny opening, a surgeon uses gentle blunt dissection to loosen the lipoma from the surrounding tissue and then applies pressure to extrude the mass through the small incision.
The ability to remove the entire fatty tumor through such a small opening depends on the lipoma’s soft, mobile nature and the surgeon’s skill. While the recurrence rate is low, similar to open excision, this method provides definitive physical removal while minimizing the visible scar.
Emerging Systemic and Ablative Approaches
Emerging treatments include non-contact energy delivery to destroy the mass. High-Intensity Focused Ultrasound (HIFU) represents an advanced ablative approach that uses highly concentrated ultrasonic energy to generate heat at a precise focal point deep within the lipoma. This thermal energy causes localized cellular necrosis, or death, to the fat cells.
HIFU is completely non-invasive, as the energy passes harmlessly through the skin to target the mass below, avoiding incision or scarring. Clinical studies have demonstrated that HIFU can achieve a substantial mean volume reduction, often around 58% over a course of four treatments, with the treated mass becoming softer. Other energy-based methods, such as radiofrequency ablation, also use heat to shrink or destroy the lipoma.
For patients with conditions like Familial Multiple Lipomatosis or Dercum’s disease, which involve numerous lipomas, localized treatments are often impractical. Researchers are investigating systemic drug treatments to address the underlying cause or prevent new lipomas from forming. A small-molecule drug, CBL-514, is currently under investigation for treating the painful lipomas associated with Dercum’s disease.
This compound, delivered via injection, is designed to induce adipocyte apoptosis, offering targeted dissolution for widespread, painful lipomas. Clinical trials have shown that the drug can significantly reduce the size of these painful lesions, with some studies reporting a greater than 50% dimension reduction.