Beyond the double-chin: The use of deoxycholic acid for non-submental fat reduction
Abstract
Deoxycholic acid is a secondary bile acid that aids in the emulsification of fat for absorption in the intestine. In 2015, Health Canada approved non-animal, non-human, synthetically derived deoxycholic acid (DCA injection: ATX-101; KYBELLA, Madison, New Jersey; BELKYRA, Canada and Sweden; KYTHERA Biopharmaceuticals, Inc., Westlake Village, CA, acquired by Allergan, Inc.) for the treatment of moderate-to-severe submental fat. Available in a 2 mL vial of 10 mg/mL solution, deoxycholic acid is injected into affected areas at 0.2cc per cm. Deoxycholic acid causes adipocytolysis one to three days after being injected directly into adipose tissue by irreversibly disrupting the adipocyte cell membrane. One week after injection, macrophages are recruited to the area, and by day 28 fibroblasts and evidence of neocollagenesis can be seen, resulting in lasting fat reduction within the treated area.
References
Center for Drug Evaluation and Research. DCA Clinical Review. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/206333Orig1s000MedR.pdf . Accessed September 5, 2022
Dayan SH, Humhrey S, Jones DH, Lizzul PF, et al. Overview of DCA (deoxycholic acid injection): a nonsurgical approach for reduction of submental fat. Dermatol Surg 2016; 42:S263-70
Rzany B, Griffiths T, Walker P, Lippert S, et al. Reduction of unwanted submental fat with ATX-101 (deoxycholic acid), an adipocytolytic injectable treatment: results from a phase III, randomized, placebo-controlled study. Br J Dermatol 2014;170:445-53
Ascher B, Hoffman K, Walker P, Lippert S, et al. Efficacy, patient reported outcomes and safety profile of ATX-101 (deoxycholic acid), an injectable drup for the reduction of unwanted submental fat: results from a phase III, randomized, placebo-controlled study. J Eur Acad Dermatol Venereol 2014;28:1707-15
Jones DH, Carruthers J, Joseph JH, Callender VD, et al. REFINE-1, a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial with ATX-101, an injectable drug for submental fat reduction. Dermatol Surg 2016;42:38-49
McDiarmid J, Ruiz JB, Lee D, Lippert S, et al. Results from a pooled analysis of two European, randomized, placebo-controlled, phase 3 studies of ATX-101 for the pharmacologic reduction of excess submental fat. Aesthet Plast Surg 2014;38:849-60
Dayan SH, Jones DH, Carruthers J, Humphrey S, et al. A pooled analysis of the safety and efficacy results of the multicenter, double-blind, randomized, placebo-controlled phase 3 REFINE-1 and REFINE-2 trials of ATX-101, a submental contouring injectable drug for the reduction of submental fat. Plast Reconstr Surg 2014;134(4 Suppl 1):123
ASDS Consumer Survey on Cosmetic Dermatologic Procedures. Available from: https://www.asds.net/consumersurvey/ . Accessed September 3, 2022
Watchmaker J, Callaghan DJ, Dover JS. Deoxycholic acid in aesthetic medicine. Adv Cosmet Surg 2020;3:77-87
Zarbafian M, Fabi SG. Off-label uses of deoxycholic acid in body contouring. Dermatol Surg 2020;46:S2-7
Sung CT, Lee A, Choi F, Juhasz M, et al. Non-submental applications of injectable deoxycholic acid: a systematic review. J Drugs Dermatol 2019;18:675-680
Liu C, Li MK, Alster TS. Alternative cosmetic and medical applications of injectable deoxycholic acid: A systematic review. Dermatol Surg 2021;47(11):1466-1472
Shridharani SM. Improvement in jowl fat following ATX-101 treatment: results from a single site study. Plast Reconstr Surg 2020;145:929-935
Montes JR, Santos E, Cillar A. Jowl reduction with deoxycholic acid. Dermatol Surg 2020;46:78-85
Carruthers J, Humphrey S. Sodium deoxycholate for contouring of the jowl: our preliminary experience. Dermatol Surg 2019;45:165-167
Mess SA. Lower face rejuvenation with injections: Botox, Juvederm and Kybella for marionette lines and jowls. Plast Reconstr Surg Glob Open 2017;5:e1551
Shridharani SM. Injection of an adipocytolytic agent for reduction of excess periaxillary fat. Aesthet Surg J 2019;39:NP495-503
Verma KD, Somenek MT. Deoxycholic acid injection as an effective treatment for reduction of posterior upper torso brassiere strap adiposity. Plast Reconstr Surg 2018;141:200e-2e
Ward CE, Li JY, Friedman PM. DCA (deoxycholic acid injection) for paradoxical adipose hyperplasia secondary to cryolipolysis. Dermatol Surg 2018;44:752-754
Jegasothy SM. Deoxycholic acid injections for bra-line lipolysis. Dermatol Surg 2018;44:757-760
Lindsey SF, Benesh G, Pavlis J, Zaiac M. Deoxycholic acid injections for the treatment of infraorbital fat pads. Dermatol Surg 2019;45:1720-1723
Amore R, Sbarbati A, Amuso D, Leonardi V, et al. Non-surgical treatment of lower eyelid fat pads with an injectable solution acid deoxycholic based. J Bio Regul Homeost Agents 2019;33:109-114
Salvador L, Benito-Ruiz J. Safety and efficacy of deoxycholic acid injection for hypogastric fat reduction: A pilot study. Dermatol Surg 2021;47(4):132-137
Amore R, Amuso D, Leonardi V, Leva F, et al. Evaluation of safe and effectiveness of an injectable solution acid deoxycholic based for reduction of localized adiposities. Plast Reconstr Surg Glob Open 2018;6:e1794
Rotunda AM, Ablon G, Kolodney MS. Lipomas treated with subcutaneous deoxycholate injections. J Am Acad Dermatol 2005;53:973-8
Dubin DP, Farberg AS, Lin MJ, Khorasani H. Intralesional deoxycholic acid as neoadjuvant treatment of a large lipoma. Dermatol Surg 2020;46:715-717
Wipf A, Lofgreen S, Miller DD, Farah RS. Novel use of deoxycholic acid for adiposis dolorosa (Dercum disease). Dermatol Surg 2019;45:1718-1720.
Patel J, Ranjit-Reeves R, Woodward J, Recurrent xanthelasmas treated with intralesional deoxycholic acid. Dermatol Surg 2020;46:847-848
Cardis MA, DeKlotz CMC. Intralesional deoxycholic acid treatment for fibrofatty residua of involuted infantile hemangiomas: a novel therapeutic approach. JAMA Dermatol 2018;154:735-737
Turkami MG. Piezogenic pedal papules treated successfully with deoxycholic acid injection. JAAD Case Rep 2018;4:582-583
Rotunda AM, Jones DH. Human immunodeficiency virus-associated lipohypertrophy (buccal fat pad lipoma-like lesions)reduced with subcutaneously injected sodium deoxycholate. Dermatol Surg 2010;36:1348-1354
