Phosphatidylcholine for the treatment of prominent lower eyelid fat pads: a pilot study.

Purpose: To find out whether the off-label use of Lipostabil is as effective as advertised for the nonsurgical treatment of bulging lower eyelid fat pads.

Methods: This is a pilot, randomized, placebo-controlled, double-blind, comparative, single-center study. Participants were 45 patients with full lower eyelids who were injected with 0.5 ml of Lipostabil in one eyelid and 0.5 ml of isotonic saline in the opposite lower eyelid as a control. Inclusion criteria were healthy adults older than 25 years. Exclusion criteria included patients with a known bleeding tendency or bleeding disorder and patients addicted to "antiwrinkle" products. The main outcome measures were reduction of lower eyelid fat pads and the occurrence of ocular or systemic side effects.

Results: The pre- and postinjection pictures of the 23 patients who completed the study were examined by 3 masked observers. They failed to differentiate the Lipostabil from the saline-injected eyelids or even the pretreatment from the posttreatment pictures in the majority of patients.

Conclusions: Mesotherapy is hailed in the media as the most exceptional discovery since the introduction of botulinum toxin. Unfortunately, we failed to observe any improvement in appearance or reduction of fullness after multiple injections. Further studies are needed to determine whether Lipostabil is indeed ineffective for the management of eyelid fullness or the dose the authors used has to be increased.