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Fat Busters: Lipolysis for Face and Neck

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Persistence and hypertrophy of fat pads particularly of the face and neck region disturb beauty proportions, thus demand treatments. Phosphatidylcholine and deoxycholic acid are the most commonly used solutions for injection lipolysis. As we stand today, sodium deoxycholate preparation is approved by the US Food and Drug Administration for the same. This article describes the correct use of solution to achieve fat reduction and ensure safety. Complete details of patient selection, assessment, dosing, and injection techniques are described in this article. A brief note on posttreatment care and complications is also provided.
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© 2018 Journal of Cutaneous and Aesthetic Surgery | Published by Wolters Kluwer - Medknow 67
Review Article
Fat Busters: Lipolysis for Face and Neck
Abhay Talathi, Prajakta Talathi
SkinSpace Clinic, Mumbai
Abstract
Persistence and hypertrophy of fat pads particularly of the face and neck region disturb beauty proportions, thus demand treatments.
Phosphatidylcholine and deoxycholic acid are the most commonly used solutions for injection lipolysis. As we stand today, sodium
deoxycholate preparation is approved by the US Food and Drug Administration for the same. This article describes the correct use of
solution to achieve fat reduction and ensure safety. Complete details of patient selection, assessment, dosing, and injection techniques
are described in this article. Abrief note on posttreatment care and complications is also provided.
Keywords: Fat busters, injection lipolysis, sodium deoxycholate, submental fat
IntroductIon
The demand for fat reduction injections in aesthetic
therapies has always been on the rise. Persistence and
hypertrophy of fat pads particularly of the face and
neck region disturb beauty proportions, thus demand
treatments. An effective reduction of this fat shall help
individuals achieve better appearance and the desired
contoured face and neck.
The history of use of fat-reducing injections goes way
back in 1960s when phosphatidylcholine was first isolated
in Ukraine[1] and subsequently used for dissolving
fat. Initially, a formulation consisting mainly of lipid
phosphatidylcholine dissolved in the bile salt deoxycholate
was used as an intravenous medication to prevent or treat
fat embolism.
HIstory In AestHetIc use[1]
In Italy, at the end of the 1980s, Dr. Sergio Maggiori
began to use phosphatidylcholine in the infiltration of
xanthelasma with satisfactory results. He presented this
method at the Fifth International Mesotherapy Congress
in Paris in 1988. In 1995, the Brazilian dermatologist,
Dr. Patricia Rittes, treated her own lower eye pads by
injecting phosphatidylcholine under her eyes. In 2003,
“Network Lipolysis” was founded in Germany by Ulrich
Bunzek and Dirk Brandl, and with this started the
European investigation of the scientific background of
this new aesthetic therapy. As we stand today, sodium
deoxycholate preparation is approved by the US Food
and Drug Administration (USFDA) for the reduction of
persistent submental fat.
VArIous FAt-dIssolVIng substAnces
Phosphatidylcholine
Phosphatidylcholine[1,2] is the most important and
essential phospholipid in the human body. It facilitates
the emulsification of fat into the tiniest particles
within the nanosphere, enabling the absorption and
transportation of fat. After subcutaneous injections
of phosphatidylcholine into fat tissue, the adipocytes
burst and phosphatidylcholine increases the secretion of
triaglycerol-rich lipoproteins.
Deoxycholic acid
Deoxycholic acid is a component of human bile acid, which
plays a vital role in emulsification and digestion of fat in
the intestine. Rotunda and colleagues[2] demonstrated that
externally developed deoxycholic acid physically disrupts
the cell membrane of adipocytes causing cell death and
Address for correspondence: Dr. Abhay Talathi,
19 Alankar, 2nd Floor, Goregaon West,
Mumbai-400104.
Ph: 9769585491.
E-mail: skinspaceclinic@gmail.com
This is an open access journal, and articles are distributed under the terms of the
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For reprints contact: reprints@medknow.com
How to cite this article:Talathi A, Talathi P.Fat busters:Lipolysis for
face and neck. J Cutan Aesthet Surg 2018;11:67-72.
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Talathi and Talathi: Fat busters
68 68 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 11 ¦ Issue 2 ¦ April-June 2018
that relatively protein-poor tissue such as fat is more
sensitive to the cytolytic effects of deoxycholic acid than
relatively protein-rich tissues such as skin and muscle.
Clinical efficacy and safety of deoxycholic acid have been
established by multiple studies.
Deoxycholic acid injection[3] (Kybella in the United States)
was approved in 2015 as a first-in-class injectable drug for
improving the appearance of double chin associated with
submental fat.
concentrAtIon oF substAnces
On reviewing literature, one realizes that multiple
variable combinations of both deoxycholic acid and
phosphatidylcholine have been tried. Some standard
combinations are as follows.
Lipostabil[4] contains phosphatidylcholine (50 mg/mL)
together with deoxycholic acid, sodium hydroxide,
sodium chloride, α-tocopherol, benzyl alcohol, and
ethanol.
Kybella contains deoxycholic acid (10 mg/mL).[3]
GeoLysis contains deoxycholic acid (10 mg/mL).
MecHAnIsM oF ActIon[5]
Following injection of lipolytic solution, the adipocyte cell
wall is destroyed, resulting in the cascade of inflammatory
necrosis of cell and reduction in the size of adipocytes.
Inflammatory cascade also results in fibroblast migration
and stimulation, resulting in buildup of more collagen
[Figure1].
IndIcAtIons
Persistent submental fat:Clinically manifests as moderate-
to-severe convexity or fullness inferior to jawline, also
termed as a double chin appearance. Till date, the use of
injection lipolysis is approved by the USFDA only in the
reduction of persistent submental fat [Figure2].
Other face and neck fat pads: Facial fats like cheek, chin
and jaw fat pads are injected by few physicians as off-label
indications. The results of these indications are variable
and techniques are not standardized as that of submental
fat injection.
A few cases of injection of fat busters in lipoma and male
breasts are also reported.
Figure 1: Mechanism of action of deoxycholic acid (Image adopted from Ref. 5)
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Talathi and Talathi: Fat busters
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 11 ¦ Issue 2 ¦ April-June 2018 69
As the most published data exist on double chin fat
reduction, we have explained the detailed technique for it
in the following sections.
Contraindications: No Absolute Contraindications exist
for procedure. It can be avoided if there is infection at the
site of injection entry. It should not be done in patients
not willing to accept the downtime of the procedure and
having unrealistic expectations.
PAtIent AssessMent
Patient assessment[6] is carried out by observing for
submental fullness in frontal and profile view of
face with Frankfort plane being parallel to the floor.
Convexities are observed and graded as follows so as
to decide dosing schedule for the patients and setting
expectations right.
Double Chin Rating Scale (Adopted from Ref. [3])
PrePArAtIon And MArkIngs
Double chin fat is located anterior to platysma muscle.
Thus, before marking the injection site, the patient is
asked to contract platysma muscle so that fat is palpated
(platysma muscle is used when the patient moves jaw
inferiorly while loudly saying “Eee”).
Submental fat compartment for deoxycholic acid
treatment is delineated by marking the submental crease
anteriorly, the hyoid bone posteriorly, and the lateral
boundaries are judged on palpation usually corresponding
with continuation of labiomental crease.
After marking the submental fat, multiple injection points
are marked at a distance of 1 cm away from each other in
a gridlike manner [Figure3].
Other important anatomic landmark is the inferior
mandibular border with the antegonial notch (a bony
landmark at the anterior masseter that approximates the
location of the marginal mandibular nerve). Marginal
mandibular nerve is located within 1 to 4 cm away from the
inferior border of mandible and is in close proximity of
antegonial notch. This area has to be cautiously injected.
InjectIon tecHnIque
Deoxycholic acid is injected into the submental fat with
the help of a 1-mL tuberculin syringe and thin needle
(usually 30 G and 13 mm)[6].
The following steps are carried out:
1. After consent and accurate photography, the injection
area is marked as explained previously.
2. Complete aseptic precautions are followed while
injecting. In our opinion, topical anesthesia does not
play any role in reducing the discomfort of injection
as fat is placed deep; however, for sensitive patients, it
may be used.
3. Typically 3–5 mL of deoxycholic acid is injected
per session divided in multiple pricks, and dose per
injection prick is close to 0.2–0.3 mL. This leads to
delivery of 30–50 mg of deoxycholic acid per session.
4. It is wise to pinch the submental fat with a nondominant
hand so as to ensure the correct plane of injection. The
depth of the prick has to be between 6 and 10 mm as
the fat is deep seated.
Figure 2: Frankfort plane (Image adopted from Ref. 3.)
Figure 3: Grid pattern of injection (Image adopted from Ref. 3)
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Talathi and Talathi: Fat busters
70 70 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 11 ¦ Issue 2 ¦ April-June 2018
5. Typically three to five sessions are required with an interval
of 4 weeks between two sessions. In our experience, the
duration between two sessions can be increased to 8
weeks so as to reduce the number of sessions.
6. Topical antibiotics are applied after injections.
7. Patients shall experience some discomfort and pain
after injection, lasting from 2days to 2 weeks followed
by reduction of fat.
PosttreAtMent cAre
Patients can experience mild swelling, discomfort, and
pain as an indicator of inflammation for the duration
varying from 2days to 2 weeks postinjection.
Patients can be aligned for the same. Cold compresses
can be effectively used to alleviate discomfort. Oral
anti-inflammatory medicines are rarely used.
Patients are instructed not to massage the treated area for
the next 48 h.
Usually, the patients can be followed up after 4 weeks to
assess the results and also to plan further sessions as per
their requirement.
clInIcAl results
1. Most of the patients treated with injection lipolysis for
the reduction of double chin are extremely satisfied
with the outcome as per our experience.
2. Reports published about the treatment results of other
body sites have claimed to achieve reduction in upper
belly by 3.7 cm, lower belly by 3.9 cm, thighs by 1.9 cm,
and upper arms by 1.6 cm.
3. For safety reasons, lower eye pads have been eliminated
from the list of lipolysis indications by the Network
Lipolysis, and the treatment should only be performed
by physicians who are able to make a releasing cut in
case of retro-orbital bleeding [Figure4].
coMPlIcAtIons[1,7]
1. Discomfort, pain, and swelling: These are most
common and shall subside with time. Swelling and
pain after only deoxycholic acid injection may last
up to 10–14 days, whereas the discomfort after
injection of the combination of deoxycholic acid and
phosphatidylcholine usually lasts for up to less than
a week.
2. Bruise/ecchymosis: These are due to injury to local
blood vessels, are very localized, and disappear in a
few days.
3. Marginal mandibular nerve injury: This is due to
injecting a lot of deoxycholic acid close to the nerve.
Clinically, it may result in asymmetrical smile. It can
be avoided with correct injection technique in most of
the individuals.
4. Skin ulceration: Superficial injection may result in
ulceration, hence should be avoided.
5. Rarely dysphagia can occur.
suMMAry
Deoxycholic acid is a first-in-class injectable drug for the
reduction of submental fat and represents a minimally
invasive, customizable alternative to liposuction and
surgery for the patients with moderate-to-severe submental
fullness.
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Talathi and Talathi: Fat busters
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 11 ¦ Issue 2 ¦ April-June 2018 71
Phosphatidylcholine combination probably helps in
the transportation of free fatty acids after breakdown.
Injection lipolysis is extremely effective and safe in the
treatment of submental fat, and usually without the need
for adjunctive treatments to address skin laxity.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal.
The patients understand that their names and initials will
not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
reFerences
1. Hasengschwandtner F. Phosphatidylcholine treatment to induce
lipolysis. J Cosmet Dermatol 2005;4:308-13.
2. Rotunda A, Suzuki H, Moy RL, Kolodney MS. Detergent effects
of sodium deoxycholate are a major feature of an injectable
phosphatidylcholine formulation used for localized fat dissolution.
Dermatol Surg 2004;30:1001-8.
3. Dayan SH, Humphrey S, Jones DH, Lizzul PF, Gross TM, Stauffer
K, et al. Overview of ATX-101 (deoxycholic acid injection): a
nonsurgical approach for reduction of submental fat. Dermatol
Surg 2016;42:S263-70.
4. Klein SM, Schreml S, Nerlich M, Prantl L. In vitro studies
investigating the effect of subcutaneous phosphatidylcholine
injections in the 3T3-L1 adipocyte model: lipolysis or lipid
dissolution? Plast Reconstr Surg 2009;124:419-27.
5. Salti G, Ghersetich I, Tantussi F, Bovani B, Lotti T. Phosphatidylcholine
and sodium deoxycholate in the treatment of localized fat: a
double-blind, randomized study. Dermatol Surg 2008;34:60-6.
Figure 4: Results of double chin reduction
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Talathi and Talathi: Fat busters
72 72 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 11 ¦ Issue 2 ¦ April-June 2018
6. Jones DH, Kenkel JM, Fagien S, Glaser DA, Monheit GD,
Stauffer K, etal. Proper technique for administration of ATX-101
(deoxycholic acid injection): insights from an injection practicum
and roundtable discussion. Dermatol Surg 2016;42:S275-81.
7. Fagien S, McChesney P, Subramanian M, Jones DH. Prevention
and management of injection-related adverse effects in facial
aesthetics:considerations for ATX-101 (deoxycholic acid injection)
treatment. Dermatol Surg 2016;42:S300-4.
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... Bu amaçla temelde deoksikolik asit (DK) ve fosfatidilkolin (FK) kullanılmaktadır. 13 İşlem ortalama 20-30 dakika sürmektedir. 3 Ortalama ayda 1 kez 4 seans şeklinde uygulama önerilmektedir. ...
... Subkutan yağ dokuya DK enjekte edildiğinde adiposit hücre zarının parçalanması yoluyla adiposit yıkımına neden olur. 13 Amfipatik ajan olan DK polar hidroksil gruplarını hücre zarı çift katmanın hidrofobik merkezine yerleştirerek zarın bütünlüğünü bozar. Böylece zarla ilişkili proteinler çözünür ve hücre zarı, fosfolipit ve DK moleküllerinin karışık misellerine çöker. ...
... Literatürde DK ve FK kombinasyonlarının kullanımları mevcuttur. 13 Enginar Ekstraktı: Luteolin, silimarin ve sinaropikrin gibi enginar özlerinin bileşenleri yağ dokusunda ve karaciğerde yağ asidi sentezinde kullanılan NAD-NADH2 ve NADP-NADPH2 koenzimlerinin sentezini arttırarak lipoliz etkisi gerçekleşir. 23 Literatürde 14 yıl boyunca 157'si liposakşın sonrası düzeltme ve 1112'si primer enjeksiyon lipoliz olan toplamda 1296 vakaya 250 mg FK ve 100 mg DK kombinasyonu (Dermastabilon ® ) yüz, submental, üst kollar, karın, sırt, yanlar, uyluklar, diz bölgesi ve baldırlara uygulanmıştır. ...
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ABS TRACT Nowadays, the tendency for non-invasive applications to achieve a more beautiful body appearance has increased. This trend has increased the demand for applications with fast-acting, quick recovery times and less complications. There are non-invasive body shaping modalities such as cry-olipolysis, ultrasound, radiofrequency, injection lipolysis, laser to reduce subcutaneous fat tissue. These modalities aim to reshape adipocyte necrosis and collagen. Appropriate modality selection in the right patient and indication leads to successful results.
... Currently, the most used and effective treatment is the reduction of facial fat by liposuction, still limited to the submental and cervical regions [7]. In addition, other minimally invasive procedures for fat compartments in facial aging are being studied, such as mesotherapy with deoxycholic acid or sodium deoxycholate and the association with other active ingredients that have proven effective for the double chin, infraorbital, submental and submental fat regions cervical [2,4,6]. ...
... Currently, facial fat reduction can be performed by liposuction only in the submental and cervical regions [7]. Other minimally invasive treatments such as subcutaneous mesotherapy with deoxycholic acid or sodium deoxycholate associated with other active ingredients are being studied in aesthetic medicine to allow treatment of other areas of the face [2,4,6]. The development of new techniques is promising, such as the subcision of adipose tissue, already used in cellulite, is believed to allow the migration of fat cells in facial compartments to other compartments with lower volume, inducing an increase in adipose tissue in deficient compartments, and increases the stimulation of collagen evidenced in the treatment of acne scars [1,5]. ...
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The aging process is characterized by ptosis of the fatty compartments of the face, loss of subcutaneous volume, weakening of the supporting structures of the face. In this process movement may occur, atrophy of the deep pads and hypertrophy of different superficial fat pads, for unknown causes, leaving the nasolabial fat prominent [3,4]. Currently, facial fat reduction can be performed by liposuction only in the submental and cervical regions [7]. Other minimally invasive treatments such as subcutaneous mesotherapy with deoxycholic acid or sodium deoxycholate associated with other active ingredients are being studied in aesthetic medicine to allow treatment of other areas of the face [2,4,6]. The development of new techniques is promising, such as the subcision of adipose tissue, already used in cellulite, is believed to allow the migration of fat cells in facial compartments to other compartments with lower volume, inducing an increase in adipose tissue in deficient compartments, and increases the stimulation of collagen evidenced in the treatment of acne scars [1,5]. As well as, the lack of standardization of mesotherapy techniques “chemical lipolysis” to reduce fat compartments. This prospective experimental clinical study was performed with 5 female patients. Clinical evidence was sought for the reduction of nasolabial fat compartments with modeling of facial fat and increase of self-esteem of patients with standardization of a new technique called lipostructure. Anthropometric measurements of the treated compartments and satisfaction research questionnaires of these patients will be used, as well as post-procedure follow-up to demonstrate the main adverse effects of this technique. The results found point to a mean reduction of 2.03% in the nasolabial fat of the patients studied (p ≤ 0.05), demonstrating its efficacy. The patient evaluation form 30 days after the procedure showed that 80% of the patients were satisfied (40% well satisfied and 40% very satisfied), demonstrating its efficiency
... 18 Injection lipolysis is a minimally invasive, targeted, fat reduction alternative that can be customized to the patient's level and area of fat accumulation. 19 One example of this uses deoxycholic acid (DCA), an adipocytolytic component of human bile acid. Although DCA mainly affects fat cells, it is relatively nonselective and has some ability to lyse muscle and other adjacent nonfatty tissues. ...
... 20,21 Despite injection lipolysis being used for decades 22 in nonsurgical, localized fat reduction, 23 only Kybella (ATX-101; Allergan Aesthetics, Irvine, CA) which contains DCA, is approved in the United States, and only for submental fat reduction. 19,24,25 In Phase II and III studies of ATX-101, [26][27][28] dose-dependent, durable, and targeted adipolysis occurred from 1 day postinjection, leading to a significant reduction in submental fat. 20 However, skin necrosis, ulceration, marginal mandibular nerve neuropraxia, and infections are known side effects of ATX-101, which is not indicated for fat reduction in other body areas. ...
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Background CBL-514 is a novel injectable drug that may be safe and efficacious for localized abdominal subcutaneous fat reduction. Objectives To assess the safety and efficacy of CBL-514 in reducing abdominal subcutaneous fat volume and thickness. Methods This Phase IIa, open-label, random allocation study consisted of a 6-week treatment period and follow-up at 4- and 8-weeks following the last treatment. Participants were randomly allocated to 1.2 mg/cm 2 (180 mg), 1.6 mg/cm 2 (240 mg), or 2.0 mg/cm 2 (300 mg) of CBL-514 with up to 4 treatments, each with 60 injections into the abdominal adipose layer. Changes in abdominal subcutaneous fat were assessed by ultrasound at follow-up visits. Treatment-emergent adverse events were recorded. Results Higher doses of CBL-514 (unit dose: 2.0 and 1.6 mg/cm 2) significantly improved the absolute and percentage reduction in abdominal fat volume (p<0.00001) and thickness (p<0.0001) compared to baseline. Although the COVID-19 pandemic halted some participant recruitment and follow-ups, analysis was unaffected, even after sample size limitations. Conclusions CBL-514 injection at multiple doses up to 300 mg with a unit dose of 2.0 mg/cm 2 is safe, well-tolerated and reduced abdominal fat volume and thickness by inducing adipocyte apoptosis. While other procedures exist to treat abdominal fat, they have limitations and may cause complications. At a dose of 2.0 mg/cm 2, CBL-514 safely and significantly reduced abdominal fat volume by 24.96%, making it a promising new treatment for routine, non-surgical abdominal fat reduction in dermatological clinics.
... 13 However, it is noteworthy that in certain countries, some practitioners perform injection lipolysis not only for body treatments, but also for reducing cheek fat pads. 17,18 In the present study, the number of patients with a history of cheek injection lipolysis was larger than that of the control group. This may be explained by the fact that most patients initially attempt to achieve a slimmer face through medical intervention. ...
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Background Although buccal fat pad removal for facial slimming has a high success rate, fibrosis in patients with a history of cheek injection lipolysis may pose challenges. Therefore, we evaluated the success rate and procedure-related complications of buccal fat pad removal in patients with a history of cheek injection lipolysis. Methods Patients who underwent buccal fat pad removal between September 2016 and February 2020 were categorized according to a history of lipolysis (injection lipolysis group versus control group). The primary and secondary outcomes were the success rate of buccal fat pad removal and the incidence of procedure-related complications, respectively. Results The study sample comprised 100 patients (14 men; 86 women; mean age, 27.49 ± 6.26 years; mean follow-up duration, 7.41 months), with 61 patients (nine men; 52 women) in the injection lipolysis group and 39 patients (five men; 34 women) in the control group. The mean buccal fat pad weight did not differ significantly between the two groups. However, the success rate was 91.8% (56/61 patients) and 100% (39/39 patients) in the injection lipolysis and control groups, respectively. Complications were exclusively observed in the injection lipolysis group [8/122 cheeks (6.6%); control group, 0/78 cheeks (0%)]. Conclusions Buccal fat pad removal effectively enhances the aesthetic appearance of the lower face. However, in patients with a history of cheek injection lipolysis, the success rate of buccal fat pad removal is lower, and the incidence of complications is significantly higher. Consequently, caution should be exercised when performing this procedure in specific patient populations.
... PC solubilized in deoxycholate has been suggested to help people lose weight by injecting it subcutaneously. Several studies have recently shown that this procedure may also be used to remove undesirable adipose tissue from various parts of the body, including the thighs, belly, neck, buttocks, and arms [10][11][12]. Deoxycholate increases the entry of PC into adipocytes; for this reason, deoxycholate is used in conjunction with PC [13,14]. In a similar study, the clinical effectiveness of NADC along with PC was investigated. ...
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Subcutaneous injections of phosphatidylcholine (PC), sodium deoxycholate (NADC), and a mixture of them were found to be an effective option for treating cellulite. However, it is noteworthy that the injection of NADC may result in inflammation as well as necrosis in the injection area. The preparation of a sustained release formulation based on lipid-liquid crystal that controls the release of NADC could be a potential solution to address the issue of inflammation and necrosis at the site of injection. To present a practical and validated approach for accurately determining the concentration of NADC in LLC formulations, spectrofluorimetry was used based on the International Council for Harmonization (ICH) Q2 guidelines. Based on the validation results, the fluorometric technique has been confirmed as a reliable, efficient, and economical analytical method for quantifying NADC concentrations. The method demonstrated favorable attributes of linearity, precision, and accuracy, with an r ² value of 0.999. Furthermore, it exhibited excellent interday and intraday repeatability, with RSD values below 4%. The recovery percentages ranged from 97 to 100%, indicating the method’s ability to accurately measure NADC concentrations. The subcutaneous injection of the LLC-NADC demonstrated a reduction in inflammation and tissue necrosis in skin tissue, along with an increase in fat lysis within 30 days, when compared to the administration of only NADC solution. Moreover, the histopathological assessment confirmed that the use of the LLC formulation did not result in any detrimental side effects for kidney or heart tissue.
... The best-known combinations of these two drugs in injection lipolysis are Lipostabil PPC (50 mg/mL), along with DC, sodium hydroxide, sodium chloride, α-tocopherol, benzyl alcohol and ethanol, and formulations differing in the value of DC, i.e., Kybella, which contains DC (10 mg/mL), and GeoLysis, which contains DC (10 mg/mL). The cascade of inflammatory response triggered by the adipocyte destruction causes the migration and stimulation of fibroblasts and, eventually, the accumulation of more collagen [30]. ...
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Adipocytes accumulate triacylglycerols as an energy store, thereby causing an increase in the adipose tissue volume. Weight gain can be prevented through damage to the adipocyte structure or an increase in the body’s metabolic rate. Commonly used methods to disintegrate the cell membrane of adipocytes include injection lipolysis, cryolipolysis, ultrasonic lipolysis, radiofrequency lipolysis, laser lipolysis, carboxytherapy, and lipolysis using an electromagnetic field. The names of these methods suggest which substances are being used, and their main advantages are a very low invasiveness, as well as effectiveness. However, new discoveries in medicine, along with individuals’ desire to improve their appearance, have resulted in numerous studies on more ways of reducing body fat. Great potential is seen in beige adipocytes, which can be transformed, i.e., “recruited” from white adipocytes, or synthesized de novo; they also show thermogenic properties. One of the stimuli inducing the formation of beige adipocytes is cold and B3-adrenergic stimulation. Based on these findings, the researchers created, for example, cooling clothing. Additionally, curcumin and natural anthocyanins have proven to be helpful in the treatment of obesity and diabetes, by stimulating the secretion of glucagon-like peptide-1, and inducing the formation of beige adipocytes. Another study showed that the conversion of white adipose tissue is indirectly influenced by interleukin-6 secreted by the muscles, the expression of which is increased in people actively exercising. Moreover, there is potential in adenosine analogs, fenoldopam, rhubarb, the herbal extract Ephedra sinica Stapf, electroacupuncture simulation, and the drug CBL-514. Despite knowledge and experience, the ideal method for a quick and noticeable, but safe and non-invasive reduction of body fat has not been found yet. The research conducted nowadays may bring us closer to the development of a universal method, and turn out to be a breakthrough in the fight against overweight and obesity.
... Имеются данные, что после инъекции липолитического раствора клеточная стенка адипоцитов разрушается, что приводит к запуску каскада воспалительного некроза клеток и уменьшению размера адипоцитов [8]. ...
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The article describes a clinical case of a five-fold administration of a direct lipolytic–phosphatidylcholine / deoxycholic acid for cosmetic purposes, which resulted in widespread septal panniculitis, systemic inflammatory reaction, secondary myositis, thrombotic microangiopathic syndrome, fatty necrosis of the pancreatic head, necrotic nephrosis and multiple organ failure, which led to death of the patient. Materials and methods . Analysis of medical records, histological examination of autopsy material. Conclusions. Injection lipolysis using phosphatidylcholine / deoxycholate causes uncontrolled necrosis of adipose and vascular tissue, fibrosis, which makes the indefinitely long-term consequences of the administration of drugs for the non-surgical treatment of subcutaneous fat deposits. Phosphatidylcholine / sodium deoxycholate is not recommended for use in the presence of general obesity, somatic pathology, or in elderly patients.
Article
This long-term study assessed satisfaction and pain levels following facial aesthetic procedures. The study also aimed to correlate expectations, and psychological and social well-being immediately and after one month, describe perceived age, and assess differences in satisfaction between injectable fillers and other Orofacial Harmonization procedures such as hyaluronic acid treatments (for dark circles, nasolabial fold lips, malar, jaw), botulinum toxin injections, enzymatic lipolysis of the double chin, micro-needling, and PDO threads. Data were collected immediately after the procedures and then again 30 days later. Among the participants, 159 (92.4%) were females and 13 (7.6%) were males, who completed FACE-Q questionnaires addressing perceived age, expectations, psychological and social well-being, satisfaction, and facial appearance, as well as the visual pain scale. The average age of the patients treated in the Dental Clinics in Brazil was 40.4 years (SD± 12.7), with 48.8% of participants perceiving themselves as older immediately after the procedures, decreasing to 47.7% after 30 days, and pain intensity was reported as low. The total number of Orofacial Harmonization procedures performed was 256. Satisfaction after 30 days was high, especially among those who received fillers. The psychological and social function scales were positively correlated with satisfaction with the decision, result, and appearance scales. Fillers showed a significant improvement in perceived age appearance, with half of the patients feeling younger after 30 days. The patients exhibited high satisfaction levels in one-month post-aesthetic orofacial harmonization procedures. Despite initially high expectations, patients reported enhanced psychological and social well-being, along with minimal pain during interventions Positive correlations were observed between satisfaction, decision-making, result perception, and appearance. Injectable fillers notably improved perceived aging, with a significant portion of patients initially perceiving themselves as older than their actual age, but later feeling younger post-procedure. Fillers also yielded superior satisfaction and pain relief compared to alternative interventions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
Article
Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.
Article
Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.
Article
ATX-101 (deoxycholic acid injection; Kythera Biopharmaceuticals, Inc. [an affiliate of Allergan plc, Dublin, Ireland]) was approved in 2015 in the United States (Kybella) and Canada (Belkyra) for submental fat reduction. As expected, injection-site reactions such as pain, swelling, and bruising, which were mostly mild or moderate and transient, were common adverse events (AEs) reported in clinical trials. An exploratory Phase 3b study investigating interventions for management of injection-site AEs associated with ATX-101 treatment was recently completed. Based on its results, literature review, and our clinical experiences, we have put forward considerations for management of AEs associated with ATX-101 treatment in clinical practice. Pretreatment with oral ibuprofen and/or acetaminophen an hour before treatment and preinjection with epinephrine-containing buffered lidocaine 15 minutes before treatment can help with management of pain and bruising. Cold application to the treated area before and immediately after the procedure may help to reduce pain (if local anesthetic preinjection is not performed) and swelling. Discontinuing medications/supplements that result in increased anticoagulant or antiplatelet activity 7 to 10 days before ATX-101 treatment, when possible, can reduce the risk of bruising. In summary, injection-site AEs associated with ATX-101 treatment can be effectively managed with commonly used interventions.
Article
ATX-101 (deoxycholic acid injection; Kybella in the United States and Belkyra in Canada; Kythera Biopharmaceuticals, Inc., Westlake Village, CA [an affiliate of Allergan plc, Dublin, Ireland]) is the first aesthetic injectable approved for reduction of submental fat. In February 2014, an injection practicum was conducted in the anatomy laboratory at the University of Texas Southwestern Medical Center to explore the proper injection technique for ATX-101 and the importance of its appropriate, safe anatomical placement within the submental area. Subsequent to the injection practicum, a structured roundtable discussion was conducted in which potential implications of the various injection protocols evaluated during the practicum were reviewed. Furthermore, the faculty had the opportunity to provide additional perspectives based on their clinical experience with facial injectables and ATX-101 specifically. In this article, the findings from the injection practicum and roundtable discussion are reported.
Article
In 2015, ATX-101 (deoxycholic acid injection; Kybella in the United States and Belkyra in Canada; Kythera Biopharmaceuticals, Inc., Westlake Village, CA [an affiliate of Allergan plc, Dublin, Ireland]) was approved as a first-in-class injectable drug for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat. ATX-101 has been evaluated in a clinical development program that included 18 Phase 1 to 3 studies supporting the current indication. Since 2007, the toxicity and safety profiles of ATX-101 have been characterized in numerous preclinical studies, its pharmacokinetics, pharmacodynamics, and optimal treatment paradigm have been defined in multiple Phase 1 and 2 studies, and its efficacy and clinical safety have been confirmed in 4 large Phase 3 trials (2 conducted in Europe and 2 in the United States and Canada [REFINE-1 and REFINE-2]). As subcutaneous injection of deoxycholic acid has been shown to cause adipocytolysis, the reduction in submental fat achieved after ATX-101 treatment is expected to be long lasting. This prediction is confirmed by data from long-term follow-up studies of up to 4 years after last treatment with ATX-101, which demonstrate that the treatment response is maintained over time in most subjects. ATX-101 offers a durable, minimally invasive alternative to liposuction and surgery for addressing submental fullness.
Article
The demand for lipolytic injection therapies for aesthetic indications increases continuously. The substance most frequently discussed in this context is phosphatidylcholine solubilized in sodium deoxycholate, a composition known in Europe as Lipostabil (Artesan Pharma, Lüchow, Germany). The evidence for its lipolytic effect is based mainly on clinical studies that suggest a decrease in adipose tissue volume after subcutaneous injections. However, neither the actual effect nor the effective supplemental effect of Lipostabil has been clearly identified so far. The purpose of this study was to investigate the effects caused by lipolytic formulations on adipocytes using an in vitro model. 3T3-L1 adipocytes in 12-well plates were exposed to varying doses of isolated phosphatidylcholine, deoxycholate, and the combination of both (Lipostabil). Subsequently, changes in the cell membrane integrity were evaluated microscopically, and assays measuring the amount of glycerol as a biochemical lipolysis substrate (lipolysis assay) together with dimethyl thiazolyl diphenyl tetrazolium assays were performed to quantify the lipolytic effect and the cell viability. Deoxycholate reduced cell viability significantly (p < 0.05), even at low concentrations. Neither phosphatidylcholine nor deoxycholate led to a significant (p < 0.05) induction of a lipolytic pathway. Lipostabil, the combination of deoxycholate and phosphatidylcholine, led to a significant (p < 0.05) decrease in cell viability at low doses and to a highly significant (p < 0.01) reduction at high doses. The loss in cell viability is attributable to changes in the cell membrane integrity. These results suggest that no enzymatic lipolytic pathway is induced. The decrease in volume after Lipostabil injections is likely attributable to the detergent effect of deoxycholate.
Article
Phosphatidylcholine injections are becoming an increasingly popular technique to treat localized fat accumulation. This formula is composed primarily of phosphatidylcholine and sodium deoxycholate, a bile salt used to solubilize the natural phospholipid in water. The mechanism through which this injectable phosphatidylcholine formulation causes localized fat reduction is unknown. To investigate the active component and mechanism of action of an injectable phosphatidylcholine formulation in clinical use. Cell viability and cell membrane lysis assays were performed on cell cultures and porcine skin after treatment with the phosphatidylcholine formula, isolated sodium deoxycholate, or common laboratory detergents Triton-X 100 and Empigen BB. In addition, we described the histologic changes after injection of these substances into porcine tissue. A significant and comparable loss of cell viability, cell membrane lysis, and disruption of fat and muscle architecture was seen in cell cultures and tissue specimens treated with the phosphatidylcholine formula and isolated sodium deoxycholate. These findings were similar to the effects produced after treatment with laboratory detergents. The phosphatidylcholine formula popularly used in subcutaneous injections for fat dissolution works primarily as a detergent causing nonspecific lysis of cell membranes. Our findings suggest that sodium deoxycholate is the major active component responsible for cell lysis. Detergent substances may have a role in eliminating unwanted adipose tissue. It is advised that physicians use caution until adequate safety data are available.
Article
The medicine Lipostabil N® has been in widespread use in Europe since 2002 by doctors working in the field of esthetics to achieve a reduction in the volume of smaller fat deposits by means of injections into the subcutaneous fatty tissue. The lipases released from the adipocytes by means of phosphatidylcholine produce a local breakdown of fat that is then discharged over the liver and metabolized via beta-oxidation. The medicine has been authorized for intravenous use in the prophylaxis and therapy of fat embolisms and liver diseases.
Article
Recent articles have introduced the novel concept of chemical lipolysis through local injections. Phosphatidylcholine is the active drug in the commercial preparation used for this purpose, but some studies have suggested that sodium deoxycholate, an excipient of the preparation, could be the real active substance. We decided to investigate whether phosphatidylcholine and sodium deoxycholate have any clinical efficacy in chemical lipolysis and their respective roles. We also studied the safety and side effects of the treatments. Thirty-seven consecutive female patients were studied for the treatment of localized fat in gynoid lipodystrophy. Each patient received injections of a phosphatidylcholine/sodium deoxycholate preparation on one side and sodium deoxycholate on the contralateral side, each single patient being herself the control. Four treatments were carried out every 8 weeks in a double-blind, randomized fashion. Metric circumferential evaluations and photographic and ultrasonographic measurements throughout the study allowed for final judgment. A statistical evaluation concluded our study. An overall reduction of local fat was obtained in 91.9% of the patients without statistically significant differences between the treated sides. Reduction values on the phosphatidylcholine/sodium deoxycholate-treated sides are in the order of 6.46% metrically and 36.87% ultrasonographically, whereas on the deoxycholate-treated sides they are in the order of 6.77% metrically and 36.06% ultrasonographically. Both treatments, at the dose used in the study, proved safe in the short term. The most common side effects were local and few, but were more pronounced on the deoxycholate-treated sides. No laboratory test was carried out. Both treatments have shown moderate and equivalent efficacy in treating localized fat, with sodium deoxycholate having a slower postoperative resolution, suggesting that sodium deoxycholate could be sufficient by itself to determine fat cell destruction and that phosphatidylcholine could be useful for obtaining a later emulsification of the fat.