Deoxycholic acid in the treatment of submental fat

Author: Dr Ian Logan, Dermatology Specialist Registrar, Hammersmith Hospital, London, UK. DermNet New Zealand Editor in Chief: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy editor: Maria McGivern. April 2017.

What is deoxycholic acid?

Deoxycholic acid is a secondary bile acid produced by intestinal bacteria acting on primary bile acids secreted by the liver. Deoxycholic acid is also known as deoxycholate and cholanoic acid.

What is deoxycholic acid used for?

Deoxycholic acid and its derivatives have been used:

What is submental fat?

Submental fat refers to the fat present in the submental region underneath the chin and at the front of the neck. Submental fat is considered cosmetically undesirable because:

Options to minimise submental fat include:

Submental fat may be assessed objectively by clinicians via the use of the Clinician-Reported Submental Fat Rating Scale (CR-SMFRS).

The patient’s subjective assessment of their submental fat may be measured via the use of the following methods:

Precautions prior to deoxycholic acid injections into submental fat

Careful clinical evaluation to exclude other causes of submental convexity/fullness (eg, enlarged thyroid, cervical lymphadenopathy) is mandatory prior to treatment. Treatment with deoxycholic acid is contraindicated:

How is deoxycholic acid administered?

Deoxycholic acid injections should be performed by a trained clinician with an understanding of submental anatomy. The target is the subcutaneous fat between the dermis and platysma (pre-platysmal fat) within the treatment area. Prior informed consent should be obtained from the patient.

The following steps are a general guide (for specific details and recommendations for use, consult the manufacturer’s product information). A topical anaesthetic, ice, or local anaesthetic may be used but is not often required.

What are the benefits of deoxycholic acid?

Five large clinical trials have demonstrated the efficacy of deoxycholic acid in the reduction of submental fat as measured by validated scales and objective measurements. Patients reported improved psychological parameters and feelings. Adverse effects were mild and temporary.

In a randomised trial that included 390 patients, 12 weeks after four treatments with deoxycholic acid, 65–70% of patients treated with deoxycholic acid were satisfied with the appearance of their face and chin compared with 30% who had received injections of inert saline (placebo).

What are the disadvantages, side effects and risks of deoxycholic acid injections?

Deoxycholic acid injections into the submental fat are generally well tolerated and side effects are usually transient. However, in clinical trials, more patients treated with deoxycholic acid 1 mg/cm2 and 2 mg/cm2 discontinued treatment because of adverse events (5.8% and 11.5%, respectively) compared with placebo (0.9%).

Side effects of the procedure are common and include:

Submental fat may re-accumulate following the procedure.

The safe and effective use of deoxycholic acid outside the submental fat region has not been established and is not recommended.

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