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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. Updated by Dr Ebtisam Elghblawi, Dermatologist, Tripoli, Libya. November 2017.
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.
Deoxycholic acid and its derivatives have been used:
Submental fat refers to the fat present in the submental region underneath the chin and at the front of the neck (preplatsymal fat). Submental fat accumulates with age, genetic predisposition and obesity. It is considered cosmetically undesirable and can lead to an adverse psychological impact.
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:
A 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:
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.
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).
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.
If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the Australian Therapeutic Goods Administration and the US Food and Drug Administration) or a national or state-approved formulary (eg, the New Zealand Formulary and New Zealand Formulary for Children and the British National Formulary and British National Formulary for Children).
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