A novel approach for deoxycholic acid administration to treat submental fullness: A case report assessed by 3D stereophotogrammetry.

Background: While effective, DAc injections for submental fat (SMF) reduction carry risks, including vascular damage and skin necrosis when improperly administered. This study presents a novel approach to SMF reduction using blunt microcannulas for DAc injections, coupled with 3D stereophotogrammetry quantification (3D-SQ). Clinical presentation: A 47-year-old female with SMF underwent two DAc applications. 3D-SQ was performed before and after each treatment using a 3D-SQ system. The patient experienced a substantial total volume reduction of 14.81 mL in the submental area after two DAc applications. 3D-SQ analysis showed a gradual reduction in submental volume over time. Importantly, no serious adverse events were reported, with only minor pain and warmth at the treated site. The reduction of SMF through DAc injections involves adipocyte cell lysis, emphasizing the importance of proper injection technique to avoid adverse events. The use of blunt microcannulas offers a safer alternative, minimizing the risk of skin necrosis, ulceration, and intra-arterial injections. Additionally, cannulas reduce bruising due to their blunt design and fan technique, enhancing patient comfort and safety. Conclusion: This case report highlights the efficacy of a novel cannula approach for DAc SMF reduction, assessed by 3D-SQ. Blunt microcannulas may represent a safer option compared to hypodermic needles, reducing the likelihood of severe complications.

Efficacy and safety of the enzymatic mixture - Lipase, collagenase and hyaluronidase - In the treatment of moderate to severe submental fat: A prospective cohort study.

Purpose: To study the effect of the enzymatic mixture: Lipase, Collagenase and Hyaluronidase in the treatment of submental fat. Methods: A monocentric prospective cohort study including 10 female patients, aged between 18 and 65 years old, who received treatment for submental fat with a mixture of Lipase, Collagenase, and Hyaluronidase. The treatment protocol consisted of one treatment session every 21 days for a total of 3 sessions. In each session, 4 ml of the enzymatic mixture (1 ml of Collagenase GH PB20, 1 ml of Hyaluronidase PB 3000 and 2 ml of Lipase PB 500) + 2 ml of Lidocaine 2% were injected in the submental fat (SMF). Efficacy was assessed four weeks after the last session. Co-Primary Outcome was defined as the improvement of ≥ 1-point in Clinician-Reported and Patient-Reported Sub-mental Fat Rating Scales (CR-SMFRS and PR-SMFRS). Secondary Outcomes included score reductions in Patient-Reported Sub-mental Fat Impact Scale (PR-SMFIS), ≥10% reduction in submental fat pad thickness by ultrasound, and Subject Self-Rating Scale (SSRS) responses of 4, 5, or 6. Results: The Co-Primary outcome was achieved in 9 out of 10 patients. A considerable reduction of 22.8% in the PR-SMFIS was observed. Furthermore, 9 out of 10 patients expressed overall satisfaction with the treatment. Submental fat reduction of more than 10% was observed in 9 out of 10 patients in neutral position and in all patients in flexed position. Adverse effects were only limited to local reactions. Conclusion: The enzymatic mixture of Lipase, Collagenase and Hyaluronidase is an effective and safe minimally-invasive method for the reduction of SMF that can be used alone or in conjunction with other treatment modalities.

Lipolytic agents for submental fat reduction: Review.

RESULT: The review delves into the realm of reducing submental fat, presenting a comprehensive analysis of various lipolytic agents used in plastic surgery and dermatology. The introduction establishes the context by defining the key indicators of a youthful neck and emphasizing the significant influence of fat in the aging process, particularly in the submental area. The usage of aminophylline involves subcutaneous injections, facilitating fat breakdown by increasing cyclic adenosine monophosphate and inhibiting adenosine receptors. Hypotonic pharmacologic lipo-dissolution induces fat dissolution via injected compounds under pressure, while lipolytic lymphatic drainage employs hyaluronidase to reduce tissue viscosity, aiding fat circulation. Glycerophosphorylcholine containing choline alfoscerate claims to activate fat metabolism, whereas the utilization of phosphatidylcholine combined with deoxycholate lacks cosmetic approval due to safety concerns. Deoxycholic acid has FDA approval for submental fat reduction, yet its mechanisms remain incompletely understood. Understanding the complex anatomy and mechanisms of lipolytic agents is essential for safe and effective submental fat reduction, despite evolving practices and off-label utilization. Clinical guidelines and references support this discussion, offering insights for safer applications.

Degradation Therapy with Collagenase and Deoxycholate.

Deoxycholate (deoxycholic acid) and collagenase are naturally occurring substances whose ability to degrade adipose tissue and collagen respectively has given rise to a variety of therapeutic applications. This article will discuss the indications for the use of deoxycholic acid, primarily its well-established role in the non-surgical reduction of submental fat, with a focus on patient assessment, procedural technique, risks, pitfalls, and key clinical tips. It will also review the indications for collagenase as a degradation therapy, its mechanism of action, and benefits in the management of wound healing, scarring, and adipose tissue modification.

Use of Intralesional Deoxycholic Acid for Antiretroviral Treatment Associated Lipohypertrophy: A Qualitative Open-Label Study of an Innovative Indication.

Background: With the advent of antiretroviral treatment (ART), human immunodeficiency virus/AIDS has become a chronic manageable disease. Though life expectancy has improved, it brings alongside effects of long-term medical treatment. One of the major side effects is body dysmorphism, which leads to esthetic problems. Problems of lipodystrophy (LDS), especially facial lipoatrophy as well as facial and upper back lipohypertrophy are perceived by patients as highly stigmatizing manifestations of their human immunodeficiency virus infection. It has been reported to affect mood and quality of life, as well as reduced adherence to antiretroviral medications. Patients feel discomfort while sleeping, dressing, and during day-to-day activities. Aim: The aim of this study was to test a relatively cost-effective and efficacious treatment modality for long-standing ART-associated lipohypertrophy of the submental fat and dorsocervical fat. Materials and Methods: This was a prospective open-label clinical study, in which 21 patients on regular ART with associated lipohypertrophy were enrolled in this open-label study. Deoxycholic acid (DCA) was given intralesionally once every 4-6 weeks. Patients were assessed for response, any adverse events, and patient satisfaction during every visit. Results: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions. Limitations: It was a small-sized sample that was studied. The lag time between starting the treatment and optimum results was long in comparison with liposuction. The result is better appreciated at the end of treatment rather than after every session implying that it has a cumulative effect. Neither pre- and post-ultrasonography nor metric documentation was done. Conclusions: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions.

Successful treatment of submental fat using a non-focused pulsed ultrasound.

BACKGROUND: The prevalence of non-invasive aesthetic treatments is increasing, with patients demanding easier, safer, and more effective non-invasive cosmetic procedures. Submental fat is usually addressed using liposuction, which is associated with significant adverse events and a long recovery. Although newer, non-invasive submental fat treatments are gaining popularity, they are often complex, require frequent injections, or have adverse side effects. AIMS: Assess the safety and efficacy of vacuum-assisted acoustic wave technology for treating submental. PATIENTS/METHODS: Fourteen female patients underwent a total of three weekly 15-min treatments using ultrasound with a 40 mm bell-shaped sonotrode. Improvement in submental fat was assessed 3 months after the final treatment using questionnaires for the patients and physicians. Two blinded dermatologists rated each patient using the Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) 5-point scale. RESULTS: Both physicians rated a significant improvement in all 14 patients. Furthermore, self-evaluation of the 14 patients on a 1 to 5 satisfaction scale averaged 2.14, indicating that most patients were somewhat satisfied. CONCLUSION: This study demonstrates that a three-treatment course with an acoustic wave ultrasound applicator with 1-week intervals leads to a significant reduction in submental fat and can be used as a novel, efficient treatment paradigm.

The Study of a Validated Assessment Scale for a Localized Submental Fat Volume.

BACKGROUND: This aim of this study was to develop an objective tool for rating submental fat applied to Koreans. METHODS: The study was conducted between April 2019 and October 2019. A total of 92 subjects were enrolled in the study. Clinical photos of the subjects were categorized using validated CR-SMFRS by three plastic surgeons and one dermatologist. The categorized photos were then shown to six different plastic surgeons for evaluation. RESULTS: The Cohen's kappa value for the six raters were 0.830, 0.742, 0.703, 0.907, 0.862, and 0.793 with statistical significance (p < 0.001). ICC value was between 0.860 and 0.966 (p < 0.001). Since the Cohen's value and ICC were above 0.6 for all raters, the ratings performed by all six raters were used in the analysis. The ICC values between raters were between 0.899 and 0.902. CONCLUSIONS: We came up with a set of reference photos that can be used for submental fat rating scale applicable to Korean subjects. LEVEL OF EVIDENCE: II.

The Efficacy of Noninvasive 1060-Nm Diode Lasers for Submental Lipolysis: A Pilot Study.

Background: Submental fat is a noticeable fat in the submental region that is of great concern aesthetically, especially to female patients. A 1060-nm diode laser is a clinically proven device for the laser lipolysis of subcutaneous fat cells. This study aimed to evaluate the safety and efficacy of a 1060-nm diode laser for submental fat reduction. Methods: Twenty subjects with unwanted localized submental fat were treated with a single session of a 1060-nm diode laser with an energy setting between 0.95 and 1.40 W/cm2, depending on each patient's tolerance. Submental fat thickness measurements were documented at baseline, and 1, 3, and 6 months after treatment. Clinical photographs, ultrasound images, and adverse events were evaluated at each follow-up visit. Subjects responded to a satisfaction questionnaire at the end of the study. Results: The subjects had a mean age of 34.55 ± 6.19 years, a mean body weight of 70.66 ± 10.55 kilograms, and most (95%) were women. The average energy setting was 0.95-1.40 W/cm2, with a pain score of 3.90 ± 1.30 on a 0-to-10 scale. A significant reduction in submental fat thickness measured by ultrasound was noted at post-treatment month 3 (falling to 0.46 ± 0.13; P = 0.013). However, there was a slight increase in the submental fat thickness at the 6-month follow-up (to 0.48 ± 0.12); the change in the thickness relative to the baseline was nonsignificant (P = 0.121). Most subjects reported an improvement 6 months after the treatment. No severe adverse events were observed throughout the study period. Conclusion: Our study demonstrated the potential role of 1060-nm Diode laser for the treatment of localized submental subcutaneous adiposities. It is a promising alternative treatment modality for patients seeking an in-office, nonsurgical procedure for fat reduction without severe complications.

Is deoxycholic acid able to reduce submental fat and increase patient satisfaction when compared to placebo groups? A systematic review.

The accumulation of submental fat (SMF) can negatively impact facial harmony appearance, and one alternative treatment for this condition is the application of deoxycholic acid (DOC). The objective of this systematic review was to answer the following question: "Is DOC able to reduce SMF and increase patient satisfaction when compared to the placebo groups?". Therefore, a detailed search strategy was carried out in 6 scientific databases (PubMed, Scopus, Embase, Lilacs, SciELO, and Web of Science) as primary search sources, while OpenGrey and OpenThesis were also used to capture the "grey literature". Only six studies met all inclusion criteria and were considered in this review analysis. The selected sample included prospective clinical studies published from 2014 to 2018, covering a total sample of 3488 patients, with an average age ranging from 46 to 49.5 years old. All selected articles evaluated the effect of DOC at concentrations of 1 mg/cm² or 2 mg/cm², using saline or placebo as control solutions for the comparative analysis. The application interval was 28 days in all studies analyzed, and the treatment duration ranged from 4 to 6 weeks. In all studies evaluated, there was a reduction in SMF and patient satisfaction with the application of DOC was higher than in the control groups at the end of a 12-week period. Thus, it is possible to conclude that the application of DOC has a positive effect on reducing SMF and improving patient satisfaction concerning their facial appearance.

Non-invasive system delivering microwaves energy for unwanted fat reduction and submental skin tightening: Clinical evidence.

BACKGROUND: Cervicomental contour represents an important aesthetic problem. AIMS: This research evaluates the safety and the efficacy of a new non-invasive system delivering microwave energy for the treatment of submental skin laxity and fat. METHODS: Forty-eight subjects underwent submental treatment with the device at hand at Poliambulatorio San Michele, Reggio Emilia, Italy. The treatment was performed on the submental area starting from 1.5 cm below the lower border of the mandible up to the hyoid bone. Treatment consisted of 6 sessions of 10 min, with a 2-week interval between each session. At the baseline and upon follow-up 12 weeks from the last treatment, the following evaluations were performed: Photographic evaluation, Clinician-Reported Submental Fat Rating Scale (CR-SMFRS), Submental Skin Laxity Grade (SMSLG), Five-Point Likert Scale Questionnaire (LSQ) for Skin Laxity, Patient-Reported Submental Fat Rating Scale (PR-SMFRS) and Numeric Rating Scale (NRS) for pain evaluation. RESULTS: Mean submental fat and laxity scores evaluation significantly decrease respectively from 3.4 ± 0.5 and 3.7 ± 0.5 at baseline to 1.7 ± 0.6 and 2.4 ± 0.6 (p < 0.01) at 12-week follow-up after the last treatment. The treatment was well-tolerated according to the NRS results. Out of the 47 participants (70.2%), 33 were very satisfied or satisfied. Most patients denied experiencing any discomfort during and after the treatment with the non-invasive device delivering microwaves. The submental subcutaneous fat reduction, the improvement of submental skin tightening, and aesthetic results are confirmed also by photographic evaluation. No side effects were observed. CONCLUSIONS: Our results showed the potential microwaves role in the treatment of localized submental subcutaneous adiposities and skin laxity.

Submental fat reduction using sequential treatment approach with cryolipolysis and ATX-101.

BACKGROUND: Submental fat (SMF) detracts from facial aesthetics and negatively impacts self-image. AIMS: To evaluate safety, effectiveness, and satisfaction of cryolipolysis and ATX-101 used sequentially to reduce SMF. METHODS: A prospective, open-label, interventional, single-site study enrolling 22- to 65-year-old participants rated as Grade 4 (extreme) on the Clinician-Rated SMF Rating Scale (CR-SMFRS). Co-primary effectiveness endpoints were proportions of participants with ≥1-grade and ≥2-grade improvement on CR-SMFRS at 12 weeks post final treatment. Additional assessments included ultrasound measurement of fat thickness and Subject Self-Rating Scale (SSRS) scores at 12 weeks post final treatment. Safety was assessed throughout the study. RESULTS: Of 16 enrolled participants, 62.5% were female, mean age of 43, and mean body mass index of 31.8 kg/m2 . 100% of participants achieved ≥1-grade improvement, and 71.4% achieved ≥2-grade CR-SMFRS improvement. Mean (SD) reduction in SMF thickness was 0.2 mm (1.3), and SSRS scores ≥4 (slightly to extremely satisfied) were reported by 71.4% of participants. Adverse events (AEs) were mild and resolved by study end. No unanticipated adverse device effects or serious or unexpected AEs occurred. CONCLUSION: Sequential treatment with cryolipolysis and ATX-101 was found safe and effective for reducing extreme SMF, resulting in approximately a 2-grade improvement.

A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction.

BACKGROUND: Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction. METHODS: Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales. RESULTS: Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8-59.2), representing a "difficult" level of reading. Mean readability grade levels (range 9-13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health. CONCLUSIONS: Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.

Adverse effects of deoxycholic acid in submandibular glands, submental, inguinal and subplantar regions: a study in rats.

OBJECTIVE: We aimed to evaluate the effects of the deoxycholic acid (DCA) in the submental and subplantar regions of rats, and to histologically analyze the changes caused in the submandibular glands, soft tissues of the paw, and inguinal adipose tissue. MATERIAL AND METHODS: Sixty male Wistar rats were divided into DCA and control (CG) groups. DCA was injected in the submental, inguinal, and subplantar regions, and saline was injected in the CG. The animals were euthanized after 24 h and at 7 and 21 days. RESULTS: The DCA group showed edema in the submental region in 24 h and in the paw in all experimental times. In the paw there were also erythema and ulceration in 7 days, and alopecia after 21 days. At 21 days, a few animals also showed erythema and ulceration in paw; however, there was no significant difference from CG. Histological analysis of the paw showed an intense inflammatory process, with a predominance of neutrophils, lymphocytes, and plasma cells in 24 h and 7 days. In the adipose tissue, we observed loss of architecture and inflammatory infiltrate, followed with a lower number of adipose cells, and at 21 days, fibroplasia. In the submandibular glands we observed inflammatory infiltration, loss of tissue architecture, and fibrosis. CONCLUSIONS: DCA produces a significant inflammatory process in the structures. It can cause skin ulcerations and, in salivary glands, it causes loss of tissue architecture and fibrosis. CLINICAL RELEVANCE: There has been growing increase in the use of DCA for aesthetic purposes by health care providers. Due to the presence of important anatomical structures in the submental region, constant vigilance is required to report new adverse effects.

Efficacy and safety of injectable deoxycholic acid for submental fat reduction: a systematic review and meta-analysis of randomized controlled trials.

Objective: To investigate the efficacy and safety of deoxycholic acid (DOC) for SMF reduction.Methods: We conducted a systematic review and meta-analysis of randomized controlled trials. We searched PubMed/MEDLINE, EMBASE, and Cochrane databases until June 2020. Efficacy outcomes: Clinician-Reported Submental Fat Rating Scale; Patient-Reported Submental Fat Rating Scale; Subject Self-Rating Scale; SMF reduction measured using caliper and resonance magnetic imaging; Early therapeutic success. Safety outcomes: Withdrawals due to adverse events (AEs), Rates of AEs, Skin laxity.Results: Five studies were included, comprising 1,838 participants. DOC (1 or 2 mg/cm2) had greater improvement in all efficacy measures compared to placebo. No differences were seen between both doses of DOC. Withdrawals due to AEs were low with 1 and 2 mg/cm2 of DOC (6.8% vs. 9.9%, respectively), and there was no difference between the two doses (p = 0.22). AEs were usually associated with the injection site, were predominantly transient, and commonly resolved within the treatment session interval. Injection site pain, hematoma, anesthesia/numbness, erythema, and swelling/edema were the most common AEs. There was no difference in their prevalence between both doses of DOC.Conclusions: DOC is effective and safe for SMF reduction with no differences between doses of 1 and 2 mg/cm2.

Deoxycholic acid in the submental fat reduction: A review of properties, adverse effects, and complications.

BACKGROUND: Deoxycholic acid (DCA) was developed by the pharmaceutical industry for aesthetical use in submental fat reduction. It represents the first lipolytic substance approved by the Food and Drug Administration (FDA) for fat reduction in that area. AIMS: This study presents an update of properties and the use of DCA, as well as adverse events and possible complications. METHODS: A search in MEDLINE/PubMed, Cochrane, and Bireme/LILACS databases was performed using the terms: "deoxycholic acid" OR "ATX-101" AND "injection" NOT "amphotericin" NOT "biliary" NOT "bile." Experimental studies developed in animals, clinical trials, literature reviews, case reports, and letters to the editor that included the DCA mechanism of action, dose, manner of use, adverse effects, and complications were selected. RESULTS: The most frequent adverse events are edema, local pain, bruise, and numbness, which usually spontaneously regress. However, complications, including, skin necrosis, nerve injury, alopecia, and vascular events, can occur, demanding complex management without specific protocols. CONCLUSION: Although DCA is beneficial for lysis of adipose tissue, clinicians should be aware about the adverse effects and risks involved with the use of this substance. The knowledge of local anatomy, properties, and adverse effects are fundamental to treatment with DCA.

Cryolipolysis for local fat reduction in adults from Brazil: A single-arm intervention study.

BACKGROUND: Localized fat is a matter of great concern among individuals from today's society. Cryolipolysis is a noninvasive technique that have shown great results in reducing localized fat. AIMS: To analyze the efficacy of cryoplipolysis on visible local fat reduction in submental region, arms, or male breast (pseudogynecomastia) in Brazilian subjects, and to assess possible factors associated with treatment success. METHODS: Single-arm, nonrandomized trial, with volunteers from both genders with visible excess fat in the arms or submental region or men presenting pseudogynecomastia. Eligible subjects were submitted to physical, photographic, and ultrasound analysis before and three months after intervention. A single cryolipolysis session was performed using specific methods for each region, followed by a local massage for two minutes. Data were described as measures of central tendency and dispersion and measures of frequency. Reduction in measurements and factors associated with treatment success was analyzed using appropriate statistical tests. RESULTS: Thirty-six subjects underwent one session of cryolipolysis in each area (22 subjects treated the arms, 20 the submental region and 9 the breast). In general, a mean reduction of 19.1% was observed. Significant differences were observed for almost all body parts analyzed. Body mass index was the only variable showing a significant relationship with intervention results. CONCLUSIONS: Cryolipolysis is a useful noninvasive tool in reduction of visible localized fat in arms and submental region and of pseudogynecomastia. Obese subjects are not benefited by the treatment.

Aesthetic evolution drives birth of minimally invasive surgery subgroup.

BACKGROUND: Facial and neck skin tightening, and rejuvenation began decades ago with maximally invasive incisional face-lift surgery. Aesthetic trends, patient demands, and innovative technology brought about minimally invasive and noninvasive interventions-such as radiofrequency, ultrasound, laser and intense pulsed light as well as dermal fillers and other injectables-to address facial and neck skin laxity. These procedures reduce facial and neck skin laxity with less risk and less downtime than maximally invasive face-lift or face-lift plus liposuction; however, these interventions are often deemed to offer reduced results. AIMS: To evaluate the safety and efficacy-as well as patient satisfaction-of Rotational Fractional Resection (RFR) in subjects with mild-to-moderate submental fat and mild-to-moderate submental skin laxity. MATERIALS: Rotational fractional resection with the Nuvellus (Recros, Inc) platform, which uses 1.5 mm in diameter rotating scalpels-termed scalpets-to resect lax skin followed by a rotating cannulas to perform focal lipectomy through resected access ports. METHODS: Thirtyone patients were evaluated 30 days after RFR, in an ongoing prospective, multi-center, nonrandomized study. RESULTS: The majority of subjects had a ≥1-grade improvement in investigator-evaluated skin laxity and lipodystrophy; 84% of subjects were satisfied with their neck and jawline appearance and 97% of subjects they would likely recommend the procedure. Minimal procedural and post-procedural pain, minimal scarring in 94% of subjects, and no severe skin-related adverse effects. DISCUSSION: Rotational fractional resection is essentially a new concept that has a risk and side effect profile that is comparable or better than-surgical skin tightening, with measurable permanent results approaching that of surgical skin tightening. This investigational procedure advances the evolution of facial and neck aesthetic procedures with results approaching those of surgery in a single treatment. CONCLUSION: Early RFR results are promising but, yet to be conclusive. However current outcome reports identify a procedure that meet patient demands for a minimally invasive office- based procedure to look better with limited downtime.

Reduction Neck Lift: The Importance of the Deep Structures of the Neck to the Successful Neck Lift.

A description of the deep structures of the neck that are responsible for submandibular fullness and a systematic surgical approach to reduce them are presented. The structures susceptible to surgical management include the subplatysmal fat, inter-sternocleidomastoid origin fat, anterior belly of the digastric muscle, hyoid bone, submandibular gland and the tail of the parotid gland. A thorough analysis of the key anatomic landmarks of the young and attractive neck is detailed in resting and dynamic positions. A clinical classification of parotid reduction in the face lift/neck lift patient is also presented.

Fat Busters: Lipolysis for Face and Neck.

Persistence and hypertrophy of fat pads particularly of the face and neck region disturb beauty proportions, thus demand treatments. Phosphatidylcholine and deoxycholic acid are the most commonly used solutions for injection lipolysis. As we stand today, sodium deoxycholate preparation is approved by the US Food and Drug Administration for the same. This article describes the correct use of solution to achieve fat reduction and ensure safety. Complete details of patient selection, assessment, dosing, and injection techniques are described in this article. A brief note on posttreatment care and complications is also provided.

Deoxycholic Acid and the Marginal Mandibular Nerve: A Cadaver Study.

BACKGROUND: One of the rare but serious complications observed with deoxycholic acid administration is damage to the marginal mandibular nerve. In this study, we evaluated if deoxycholic acid directly induces histologic damage to fresh cadaveric marginal mandibular nerve. METHODS: A segment of marginal mandibular nerve was harvested from 12 hemifaces of 6 fresh cadavers. The nerve specimen was exposed to either 0.9% sterile saline for 24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxycholic acid (10 mg/ml) for 24 h. The nerve specimens were then fixed in glutaraldehyde for a minimum of 24 h. Toluidine blue stained sections were evaluated for stain intensity using light microscopy and color deconvolution image analysis. Supraplatysmal fat was harvested as a positive control and exposed to the same treatments as the marginal mandibular nerve specimens, then evaluated using transmission electron microscopy. RESULTS: Toluidine blue staining was less in the marginal mandibular nerve exposed to deoxycholic acid when compared to saline. The specimen exposed to deoxycholic acid for 24 h showed less toluidine blue staining than that of the nerve exposed to deoxycholic acid for 20 min. Transmission electron microscopy of submental fat exposed to deoxycholic acid revealed disruption of adipocyte cell membrane integrity and loss of cellular organelles when compared to specimens only exposed to saline. CONCLUSIONS: Deoxycholic acid (10 mg/ml) damages the marginal mandibular nerve myelin sheath in fresh human cadaver specimens. Direct deoxycholic acid neurotoxicity may cause marginal mandibular nerve injury clinically. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .