Deoxycholic acid in the treatment of submental fat

What is deoxycholic acid?

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

• Deoxycholic acid emulsifies fats to help their intestinal absorption.
• When injected into subcutaneous fat, deoxycholic acid destroys adipocytes (fat cells). the inflammatory The tissue reaction leads to reduced fat and minimal scarring.
• Deoxycholic acid is less destructive on skin and muscle tissue due to protein binding.
• Kybella^® (Allergan) is a proprietary formulation of purified synthetic deoxycholic acid initially developed by Kythera Biopharmaceuticals for therapeutic use. In some countries, including New Zealand, it is marketed as BELKYRA®.

What is deoxycholic acid used for?

Deoxycholic acid and its derivatives have been used:

• In the food industry as emulsifiers.
• To prevent and dissolve gallstones.
• Under investigation as a biological detergent
• In mesotherapy to produce lipolysis (e.g., as a nonsurgical treatment of lipoma)
• Kybella is approved by the U.S. Food and Drug Administration as an injectable medication to improve the appearance of moderate to severe convexity or fullness associated with submental fat.

What is submental fat?

Submental fat refers to the fat present in the submental region under the chin and in the front of the neck (preplatsymal fat). Submental fat accumulates with age, genetic predisposition and obesity It is considered cosmetically undesirable and may cause adverse psychological impact.

Options to minimize submental fat include:

• Surgical rejuvenation (face and neck lift)
• Targeted liposuction
• Cryolipolysis
• To be ablation
• Radiofrequency contouring
• Ultrasound lipolysis
• Submentoplasty
• Chin implants
• Deoxycholic acid injections.

Submental fat can be objectively assessed by physicians by using the Physician-Reported Submental Fat Score Scale (CR-SMFRS).

The patient's subjective assessment of their submental fat can be measured by using the following methods:

• The Subject Self-Rating Scale (SSRS)
• The Patient-Reported Submental Fat Rating Scale (PR-SMFRS).

Precautions Before Deoxycholic Acid Injections into Submental Fat

• Postpone treatment if there is a infection at the treatment site.
• Avoid current or local anesthesia If the patient is allergic to these.
• Make sure the swelling is due to fat (consider cervical thyromegaly lymphadenopathy, submandibular ptosis, scarring and excessive skin laxity).

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

• If the patient is sensitive to any component of the treatment medication.
• If excess skin (rather than fat) is the cause of an adverse profile
• During pregnancy or breast-feeding (there is insufficient safety data)
• If there has been previous surgical or aesthetic treatment of the submental region
• If the patient has a bleeding disorder or takes anticoagulants or antiplatelet agents.
• If there is a current or previous history of, dysphagia (difficulty to swallow)

How is deoxycholic acid administered?

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

The following steps are a general guide (for specific details and usage recommendations, see the manufacturer's product information). A topic anestheticIce or local anesthesia may be used, but is often not required.

• A “tattoo grid” of ink can be applied to the area to be treated to guide the administration of injections; This is removed with an alcohol swab after treatment.
• Deoxycholic acid is injected subcutaneously in doses of 0.2 ml, 1 cm apart, into the submental fat treatment area. The concentration used is 10 mg/ml (2 mg/cm²) A 30 gauge (or smaller) needle that is 0.5 inches long is used.
• Up to 50 individual injections can be injected per treatment session, which is equivalent to a maximum of 10 ml of deoxycholic acid.
• Bruising and pain after treatment can be relieved with compression dressings, cold compresses, and oral analgesia.
• Treatment may be repeated at intervals of 4 to 8 weeks. Most patients receive 2 to 4 treatments and up to six treatments may be given.

What are the benefits of deoxycholic acid?

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

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

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

Deoxycholic acid injections into 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 treatment interrupted due to adverse events (5.8% and 11.5%, respectively) compared to placebo (0.9%).

Side effects of the procedure are common and include:

• Pain at the injection site.
• Bruising
• Numbness and tenderness
• Temporary redness and swelling.
• Hardening at the injection site
• Depressions at the injection site.
• Dysphagia
• Nerve injury that causes temporary numbness.
• Skin ulceration (rare), due to too superficial an injection into the dermis
• Temporary or persistent beard hair The loss has been reported.

Submental fat can accumulate again after the procedure.

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