Dr Leow Aik Ming
The area under the chin and front of the neck (submental region) plays an essential role in the appearance of youthfulness and aesthetic of the face and neck. A double chin, also known as submental fat, is a common condition that occurs when an excessive amount of fat is formed below the chin. Double chin is considered cosmetically undesirable. It is often associated with the sign of ageing, weight gain and sometimes skin laxity due to genetics.
With the recent advances in non-surgical fat reduction technology, it’s now possible to shed that double-chin without going under the knife. One of the latest and promising discoveries in chemical compounds used for fat dissolving purposes is synthetic deoxycholic acid. This synthetic deoxycholic acid is marketed as Kybella or Belkyra or Cincelar Plus.
Originally, deoxycholic acid is a type of secondary bile acid that is produced in the liver. This compound is produced naturally in the human body by intestinal bacteria action. Deoxycholic acid is vital in ensuring that the normal digestive process happens smoothly as it emulsifies dietary fats in the intestine. Deoxycholic acid also facilitates absorption and excretion of fats and sterols in the intestine as well as in the liver.
Synthetic deoxycholic acid is classified as a cytolytic medication, as it works by disrupting the cell membrane of adipose cells and stimulating targeted disintegration of fat cells. The adipocyte cytolysis process is followed by an inflammatory reaction that helps with clearing the broken-down fat cell remnants by macrophages. However, the efficacy of deoxycholic acid can be affected by albumin and tissue-associated proteins. Hence, it can only be used to shrink protein-poor subcutaneous adipose tissues. Other tissues like skin, muscles, and bone remain unaffected by deoxycholic acid.
Method of administration of synthetic deoxycholic acid injections:
Synthetic deoxycholic acid comes in the form of liquid injectable and is meant to be injected subcutaneously into the excessive fat tissues. The injection area and the number of treatment sessions depend primarily on the patient’s condition and response to treatment.
Side effects of synthetic deoxycholic acid injections:
Following the treatment session, patients will notice a gradual reduction of the submental fat. However, patients may also experience undesirable side effects such as injection site reactions, including pain, numbness, swelling, and bruising; headache; and nausea. Patients may also experience adverse side effects, including weakness of the facial muscles, pain or tightness in the face or neck, and difficulty swallowing. These reactions require immediate medical attention at the nearest hospital to prevent serious health complications.
Precautions before synthetic deoxycholic acid injections into submental fat:
- Postpone treatment if there is an infection at the treatment site.
- A careful clinical evaluation to exclude other causes of submental convexity/fullness (e.g., enlarged thyroid, cervical lymphadenopathy) is mandatory before treatment.
Treatment with synthetic deoxycholic acid injections are contraindicated:
- If the patient is sensitive to any component of the treatment drug
- If excess skin (rather than fat) is the cause of an adverse profile
- During pregnancy or lactation (there is insufficient safety data)
- If there has been a prior surgical or aesthetic treatment of the submental region
- If the patient has a bleeding disorder or is on anticoagulants or antiplatelet agents
- If there is current, or a prior history of, dysphagia (difficulty swallowing).