Non-Submental Applications of Injectable Deoxycholic Acid: A Systematic Review

July 2019 | Volume 18 | Issue 7 | Original Article | 675 | Copyright © July 2019

Calvin T. Sung MD,ab Alfred Lee BA,ª Franchesca Choi BS RPh,B Margit Juhasz MD,B Natasha Atanaskova Mesinkovska MD PhDb

ªUniversity of California, Riverside School of Medicine, Riverside, CA

BUniversity of California, Irvine, Department of Dermatology, Irvine, 

Abstract

Introduction: Injectable deoxycholic acid (DCA; Kybella; Allergan, Irvine, CA) is currently approved only for treatment of persistent submental fat (SMF). Many cosmetic surgeons use DCA off-label to treat fat tissue in other areas of the body. There is no review summarizing the off-label uses of injectable DCA. 


Methods:
A systematic literature search was conducted through PubMed, Cochrane, CINAHL, and Web of Science databases using search terms “ATX-101 OR Kybella OR deoxycholic OR deoxycholate NOT amphotericin NOT bile” in accordance to PRISMA guidelines to identify off-label uses for injectable DCA or ATX-101. 


Results:
Ten pertinent articles were identified for review. Anatomic areas treated include the face, brassiere line, foot, and gluteotrochanteric region. Indications include facial contouring, paradoxical adipose hyperplasia, HIV/HAART-associated buccal fat pad lipodystrophy, and reduction of lipomatous tumors. DCA is efficacious at causing lipolysis and safe with minimal side effects. Most patients treated for cosmetic indications reported high patient satisfaction. 


Conclusion:
Off-label use of injectable DCA demonstrate a similar safety profile, effectiveness, and overall patient satisfaction compared to FDA-approved use for persistent SMF. DCA appears to be a safe and efficacious alternative to surgical reduction of unwanted adipose tissue in non-submental areas. Larger-scale studies are warranted to explore further cosmetic and potential medical applications. 


J Drugs Dermatol. 2019;18(7):675-680. 

INTRODUCTION

Injectable deoxycholic acid (DCA) is currently United States Federal Drug Association (FDA) indicated for treatment of moderate-to-severe submental fat (SMF), typically presenting as excessive inferior jawline fullness, or colloquially, “double chin.”1 Prior to the discovery and use of DCA, phosphatidylcholine (PC), a naturally occurring phospholipid that emulsifies fat, was used as a lipolytic agent to prevent or treat venous fat embolism. Eventually, its use evolved to include local reduction of adipose tissue for aesthetic purposes.

DCA is the lipolytic component of human bile acid that disrupts adipocyte cell membranes, which results in cell death while sparing protein-rich skin and muscle tissue remains unaffected.2 Necrosis following lipolysis reduces adipocyte size through inflammatory, cell-mediated fibroblast activation and collagen deposition, while simultaneously strengthening structural integrity of underlying tissue.3 Histologically, inflammation is localized to the pannus. Several preclinical and clinical studies have established a favorable safety profile for injectable DCA and efficacy for SMF reduction.1 This manuscript will systematically review and discuss pertinent findings from all available literature regarding off-label injectable DCA application for lipolysis in non-submental regions of the body.

MATERIALS AND METHODS

Literature Search
This systematic review was done in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).4 A primary literature search was conducted using PubMed, Cochrane, Web of Science and CINAHL. Two authors (CS/FC) independently screened the above-mentioned databases using the search term, “ATX-101 OR Kybella OR deoxycholic OR deoxycholate NOT amphotericin NOT bile,” utilizing Medical Subject Headings (MeSH®) controlled vocabulary and text words. Systematic literature search was conducted on November 26, 2018.

Study Selection and Appraisal
Two reviewers (CS/FC) independently screened all article titles and abstracts to include clinical trials, cohort studies, case-control studies, case series, cross-sectional studies, or case reports, written in English, on off-label use of deoxycholic acid or deoxycholate in human subjects apart from its approved indication of submental fat reduction. Animal studies and articles not available in English were excluded. There were no date exclusions applied to this search. Subsequently identified studies were subjected to full-text review. Authors were contacted for missing data. Bias risk and methodological quality were assessed