A 2014 survey conducted by the American Society for Dermatologic Surgery showed that 68% of people are bothered by a double chin. To date, surgical liposuction has been the only treatment to eliminate this stubborn fat, and this procedure comes along with recovery time and risk of scarring. Fortunately, this is no longer the case in the United States thanks to the FDA approval of deoxycholic acid, a first-of-its-kind injectable treatment for submental fat (aka a double chin) that permanently dissolves fat and helps achieve a slimmer, more streamlined profile.

I performed the clinical research trials that led to the approval of deoxycholic acid, so I’ve been using it for almost four years. I was very excited when the FDA approved this treatment at the end of 2015 because I was very impressed with the results of the research study. I use many fat-reducing treatments in my dermatology practice, but deoxycholic acid is different because it effectively reduces fat in the small area under the chin, which larger fat-shrinking devices cannot reach.

The company that developed the first deoxycholic acid for treatment of fat under the chin (known as the submental area) decided to seek FDA approval because this area makes both men and women feel self-conscious about their appearance. This fat is often resistant to diet and exercise, and is most influenced by age and genetics. Deoxycholic acid has become extremely popular with men who otherwise have resisted cosmetic treatments. After seeing the results achieved, I have found my male patients to be more open to exploring other treatments such as fillers and toxins.

Deoxycholic acid is a naturally occurring substance that breaks down dietary fat in the body. It is precisely injected into the troublesome areas, and allows physicians to selectively target fat. The treatments involve two to four injection sessions spaced one month apart.

The treatments themselves are rather fast and easy. First, I numb patients with lidocaine prior to injecting (I also advise them to take acetaminophen before their appointment) and then use a white washable pencil to outline the treatment area. Then, a grid is placed on the treatment area using a temporary tattoo. I inject deoxycholic acid into each “dot” on the grid, and then apply a cold compress wrapped in alcohol-soaked gauze to the treatment area for a few minutes. (This helps remove the grid without manually manipulating the injection sites). Finally, I apply an arnica patch to minimize the chances of bruising.

Possible side effects include stinging for about 20 minutes after treatment, as well as mild bruising, pain and numbness. Patients must be made aware of the significant swelling that occurs after treatment, as the area often looks worse than it did prior to the injections. The level of swelling depends on the amount of fat the patient has, so the larger the treatment area, the more severe the swelling will be. Swelling can last for up to two weeks, but this reaction lessens with subsequent treatments. I do not advise patients to take anti-inflammatory medications such as ibuprofen after treatment to reduce swelling. I have found that the inflammation is actually beneficial, as it helps maintain the skin’s tightness as fat is reduced over the course of treatment.

Numbness can last for four to six weeks after each treatment, but it is temporary and the upside is that the patient feels less discomfort during their next treatments. Firmness in the treatment area is another side effect, and this is the result of immune cells migrating to the area to help flush away the destroyed fat cells, but massaging the area can help. Though rare, nerve damage is a more serious potential side effect, but the risk is easily reduced by using proper injection techniques. It’s also essential to avoid injecting deoxycholic acid into salivary glands, lymph nodes, muscles or the thyroid, as it has a detrimental effect on any type of tissue other than fat.

I have not seen a need for skin-tightening treatments after the treatment since it seems the swelling associated with the treatment has a skin-tightening effect, but injectable fillers and toxins can help enhance the results. I often use filler along the jawline or in the chin to provide further definition. In some cases, the reduction of fat can make vertical platysmal bands on the neck appear more prominent. Injecting a toxin before, during the same appointment or after the treatment helps soften their appearance and enhance the overall results

Although deoxycholic acid is not yet available outside of the United States, I would say it’s just a matter of time based on its popularity here. This innovative drug offers a non-invasive way to improve a very common cosmetic concern, and I’m thrilled that it’s part of my aesthetic toolkit.

To see before-and-after photos, be sure to visit the Skin Type Solutions YouTube channel!