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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.
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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.
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Técnicas Cosméticas , Ácido Desoxicólico , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Injeções Subcutâneas , Estudos ProspectivosRESUMO
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.
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Ácido Desoxicólico , Glândula Submandibular , Tecido Adiposo , Animais , Ácido Desoxicólico/toxicidade , Estética Dentária , Masculino , Ratos , Ratos WistarRESUMO
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.
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Técnicas Cosméticas , Ácido Desoxicólico/administração & dosagem , Gordura Subcutânea/efeitos dos fármacos , Queixo , Colagogos e Coleréticos/administração & dosagem , Colagogos e Coleréticos/efeitos adversos , Ácido Desoxicólico/efeitos adversos , Humanos , Injeções Subcutâneas , Imageamento por Ressonância Magnética , Pescoço , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
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.
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Técnicas Cosméticas , Ácido Desoxicólico , Tecido Adiposo , Animais , Técnicas Cosméticas/efeitos adversos , Ácido Desoxicólico/efeitos adversos , Injeções , LipóliseRESUMO
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.
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Lipectomia , Adulto , Brasil , Feminino , Humanos , Masculino , Satisfação do Paciente , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/cirurgia , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below -11°C have not been used to treat the submental region. OBJECTIVE: The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time. METHODS: A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at -12 and -15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI). RESULTS: The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment. CONCLUSION: Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.