Misha Zarbafian, S. Fabi
Oct 1, 2020
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Influential Citations
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Journal
Dermatologic Surgery
Abstract
Deoxycholic acid (DCA) is a noninvasive treatment for unwanted localized subcutaneous fat, which has shown great efficacy in reducing submental fullness. Deoxycholic acid (Kybella; Allergan, Irvine, CA) became the only Food and Drug Administration–approved injectable treatment for the reduction of moderate to severe convexity or fullness associated with submental fat in adults in 2015. Rotunda and colleagues first identified DCA as an active ingredient with a potential role in the elimination of unwanted adipose tissue. It was later reported by Thuangtong and colleagues that the cytolytic effects of DCA were reduced in protein-rich tissues, which explained the mechanism behind its heightened activity in protein-poor tissues such as fat. A Phase 1 study of elective abdominoplasty patients reported histologic changes after DCA administration that supported its lipolytic effects. Lysis of adipocyte cell membranes and neutrophilic infiltration were visible on Day 1 and Day 3 after DCA administration, respectively. Macrophages had been recruited to the treatment area byDay 7 to clear cellular debris, and by Day 28 fibroblast, recruitment and induction of neocollagenesis were visible. In total, 18 clinical studies (Phases 1–3) were conducted before DCA receiving FDA approval, providing a unique, efficacious, and noninvasive alternative to more traditional procedures such as surgery or liposuction. Published data have successfully replicated the efficacy and safety profile of DCA in the clinical setting outside of clinical trials. Although the safety and efficacy of DCA for the reduction of subcutaneous fat outside the submental region has not been formally approved, several offlabel indications have been investigated and reported. This review will examine potential off-label indications for DCA in body contouring, including those previously reported in the literature as well as the personal experiences of the author (S.G.F.). The authors have included the jowls as an indication as it is one of the more studied areas for DCA use.