Safe Deoxycholic Acid Injection Technique for Submental Fat Reduction

Abstract

Body contouring is gaining popularity in the aesthetic world, as many patients are opting for non-surgical treatments to reduce fat and to improve their appearance. Prior to 2015, patients seeking cosmetic enhancement to reduce submental fat (SMF) typically underwent submental liposuction. Health Canada and the United States Food and Drug Administration approved deoxycholic acid for the reduction of moderate-to-severe SMF in 2015. Deoxycholic acid (BELKYRA™, Allergan, Madison, NJ) is a minimally invasive injectable treatment for the non-surgical reduction of submental adipose tissue. It is a synthetic bile acid that acts on adipocytes by emulsifying fats. Upon injection in the submental fat, it disrupts plasma membranes and ultimately induces adipocyte cell lysis. This is followed by an inflammatory reaction, with a subsequent reduction in fat. The swelling takes up to a week to resolve, and then tissue remodelling takes place over months. In one of the early randomized controlled trials (RCT) comparing deoxycholic acid to placebo, between 64 – 69% of patients (n=360) were highly satisfied with the appearance of their face and chin using the Subject Self-Rating Scale (SSRS score ≥4) after up to 4 treatments compared to 29% in the placebo group (P < 0.001). Deoxycholic acid injection can be a safe and effective addition to a dermatologist’s cosmetic practice, with a high rate of patient satisfaction.

The first portion of this article will address the safety concerns of deoxycholic acid treatment, outlining not only the common adverse effects (AEs) but also highlighting rare side effects that have been reported in case reports and case series. The second portion of the article will review patient selection, anatomic considerations, and injection techniques to achieve a safe outcome.