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Sirimahachaiyakul P, Tansawet A, Wannachamras S. Success Rate of Buccal Fat Pad Removal in Cases of Previous Injection Lipolysis of the Cheeks: A Comparative Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5410. [PMID: 38025637 PMCID: PMC10653592 DOI: 10.1097/gox.0000000000005410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
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.
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Affiliation(s)
- Pornthep Sirimahachaiyakul
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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McDonald L, Hoffman L, Chapas A. Degradation Therapy with Collagenase and Deoxycholate. Facial Plast Surg Clin North Am 2023; 31:525-533. [PMID: 37806686 DOI: 10.1016/j.fsc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Deoxycholate (deoxycholic acid) and collagenase are naturally occurring substances whose ability to degrade adipose tissue and collagen respectively has given rise to a variety of therapeutic applications. This article will discuss the indications for the use of deoxycholic acid, primarily its well-established role in the non-surgical reduction of submental fat, with a focus on patient assessment, procedural technique, risks, pitfalls, and key clinical tips. It will also review the indications for collagenase as a degradation therapy, its mechanism of action, and benefits in the management of wound healing, scarring, and adipose tissue modification.
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Affiliation(s)
- Louise McDonald
- Department of Dermatology, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland BT16 1RH, UK.
| | - Lauren Hoffman
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, NY 10003, USA
| | - Anne Chapas
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, NY 10003, USA
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Shridharani SM, Dayan S, Biesman B, Cohen J, Downie J, Jones D, Shamban A, Fabi S, Yoelin S, Fagien S, Ablon G, Gold M, Gueta R, Walker P. Efficacy and Safety of Tapencarium (RZL-012) in Submental Fat Reduction. Aesthet Surg J 2023; 43:NP797-NP806. [PMID: 37348516 PMCID: PMC10501747 DOI: 10.1093/asj/sjad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Tapencarium (RZL-012) (5-(3.6-dibromo-9H-carbazol-9-yl)-N, N, N-trimethylpentan-1-aminium chloride) is a novel injectable synthetic molecule with cytolytic properties, capable of reducing subcutaneous fat volume. OBJECTIVES The goal of this 3-armed, randomized, double-blind, placebo-controlled phase 2b study was to determine the safety and efficacy of low- and high-dose RZL-012 vs placebo on submental fat (SMF) reduction. METHODS Patients (n = 151, age 18-65 years) with excess SMF received a single treatment session of RZL-012 or placebo in the submental area, after which they were monitored for 84 days. SMF was assessed at baseline and after dosing with newly developed scales, namely the Clinician Chin Assessment Tool (C-CAT) and Subject Chin Assessment Tool (S-CAT). SMF was also assessed by magnetic resonance imaging (MRI) at screening and on Day 84 after treatment. RESULTS The proportion of patients who had a 1-grade or 2-grade improvement in C-CAT and/or S-CAT on Day 84 vs baseline was significantly higher in the high-dose RZL-012 group vs the placebo group (P < .002). The relative percentage reduction in MRI-measured SMF volume (Day 84 vs screening) was significantly greater in the high-dose RZL-012 group vs the low-dose RZL-012 or the placebo group (P < .0001). Local injection site reactions were the most common adverse events (AEs). CONCLUSIONS A single administration of RZL-012 into SMF resulted in significant improvement in submental appearance as assessed by clinicians, patients, and MRI. From a safety perspective, there were no serious AEs and no clinically significant changes in vital signs or laboratory tests over the course of the study. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Sachin M Shridharani
- Corresponding Author: Dr Sachin Shridharani, 880 Fifth Avenue, #1A/B/C/D, New York, NY 10021, USA. E-mail:
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Khan H, Ul Ain N, Bhatti DS, Khan J. An Assessment of the Reduction of Submental Fullness With ATX-101 (Deoxycholic Acid Injection) in the Expanded Safe Zone. Cureus 2023; 15:e35286. [PMID: 36968884 PMCID: PMC10037223 DOI: 10.7759/cureus.35286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Background and objective Facial aesthetics have a huge impact on how individuals view themselves and are viewed by society. The aesthetics of the face are tremendously influenced by the shape of the chin and neck. In this study, we aimed to observe the outcomes in individuals after the use of ATX-101 (deoxycholic acid injection) in an expanded safe zone for submental fullness. To ensure optimal outcomes and reduce the risk of adverse events, appropriate patient selection is the key. ATX-101 treatment may be administered in combination with hyaluronic acid fillers, botulinum toxins, cryolipolysis, and radiofrequency treatment. This is the first study of its kind to be carried out at the national level in Pakistan. Materials and methods This was a quasi-experimental study conducted at the Rawalian Burn and Reconstructive Surgery Unit, Holy Family Hospital, Rawalpindi, Pakistan for a period of nine months, from 10-1-2021 to 11-10-2021. A total of 62 patients who fulfilled the inclusion criteria were enrolled. We recorded if any complications had occurred or not. Moreover, the total number of treatment sessions, the volume of injectables used, and the interval between sessions were also documented. ATX-101 package was injected into the treatment area. Due care was taken to avoid the region of the marginal mandibular nerve. After the procedure, outcomes and complications were observed. Results In this study, patient satisfaction was reported in 59 (95.2%) patients. After the fourth session, final improvement was observed in 59 (95.16%) patients. Tenderness was found in seven (11.3%) patients, bruising was noted in four (6.5%), edema was found in seven (11.3%), numbness was noted in one (1.6%), whereas paresis and alopecia were not found in any of the patients. Conclusion Our study concluded that ATX-101 is a very useful modality with fewer complication rates and is associated with significant improvement in the expanded safe zone for submental fullness.
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Humphrey S, Munavalli GS, Yoelin SG, Friedmann DP, Kavali CM, Sangha S. Submental Area Treatment with ATX-101: Relationship of Mechanism of Action, Tissue Response, and Efficacy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4250. [PMID: 37073386 PMCID: PMC10106193 DOI: 10.1097/gox.0000000000004250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/09/2022] [Indexed: 04/20/2023]
Abstract
ATX-101 is an injectable, synthetically derived formulation of deoxycholic acid used for submental fat reduction. Methods A narrative review of references relevant to the mechanism of action of ATX-101 and its relationship to efficacy and inflammatory adverse events was conducted. Results When injected into subcutaneous fat, deoxycholic acid physically disrupts adipocyte cell membranes, leading to local adipocytolysis, cell death, and a mild, local inflammatory reaction consisting of macrophage infiltration and fibroblast recruitment. At Day 28 postinjection, inflammation largely resolves, and key histologic features include fibrotic septal thickening, neovascularization, and atrophy of fat lobules. Based on the mechanism of action of ATX-101 and the demonstrated inflammatory response, localized inflammation and swelling are expected following treatment. Indeed, postinjection swelling and other local injection-site events, including pain, erythema, and bruising, are common during and after treatment. Because of inflammatory sequelae following injection, reduction in submental fat is gradual and may require months before the full response is apparent. Patients may also require multiple treatment sessions to achieve their treatment goals. Repeated treatments may result in less pain and swelling over time owing to a combination of factors, including less target tissue allowing for lower doses/injection volumes, persistent numbness, and greater tissue integrity from thickened fibrous septa. Conclusions Physicians can manage expectations by counseling patients that, based on the mechanism of action of ATX-101 and data from pivotal clinical trials, ATX-101 treatment results in localized inflammation/swelling and gradual submental fat reduction. Patient education about common local adverse events is critical.
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Affiliation(s)
| | - Girish S. Munavalli
- Dermatology, Laser, & Vein Specialists of the Carolinas, PLLC, Charlotte, N.C
| | | | - Daniel P. Friedmann
- Westlake Dermatology Clinical Research Center, Westlake Dermatology & Cosmetic Surgery, Austin, Tex
| | | | - Sara Sangha
- Allergan Aesthetics (an AbbVie Company), Irvine, Calif
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Shridharani SM, Tisch GM. Commentary on: Improvements in Submental Contour Up to 3 Years After ATX-101: Efficacy and Safety Follow-Up of the Phase 3 REFINE Trials. Aesthet Surg J 2021; 41:NP1540-NP1542. [PMID: 33728444 DOI: 10.1093/asj/sjab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Safety and Efficacy of Deoxycholic Acid Injection for Hypogastric Fat Reduction: A Pilot Study. Dermatol Surg 2021; 47:e132-e137. [PMID: 33795572 DOI: 10.1097/dss.0000000000002823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although deoxycholic acid (DCA) has been proposed for use in other areas, it is used primarily for treating moderate-to-severe fat in the submental area. OBJECTIVE To evaluate the safety and efficacy of DCA for fat reduction in the hypogastric region. MATERIALS AND METHODS A prospective, longitudinal, nonrandomized, open-label, interventional pilot study was performed. Deoxycholic acid was transcutaneously injected in upper right, upper left, lower right, and lower left hypogastric zones. Fat thickness was assessed using calipers, ultrasound, and 3-dimensional scanning. The primary end point safety was evaluated by laboratory tests and the incidence of adverse events. RESULTS Fourteen patients (54 treatment sessions) were included. The mean total volume administered was 26.6 mL. The main local adverse events were edema (94.4%), bruising (90.7%), and erythema (79.6%), all being self-limited (the mean duration 9.6, 7, and 2 days, respectively). A DCA dose was significantly associated with erythema duration (p = .0421) but not with edema duration (p = .1611) or bruising incidence (p = .1013). Measurement using calipers, ultrasound, and 3-dimensional scanning revealed significant fat thickness reduction. Patient-reported outcome measure scores revealed a significant improvement in patient satisfaction. CONCLUSION Deoxycholic acid may be a safe and effective option for reducing fat thickness in the hypogastric region, although given the cost/benefit ratio probably should be reserved for small deposits.
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Best Clinical Practices with ATX-101 for Submental Fat Reduction: Patient-related Factors and Physician Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3668. [PMID: 34262836 PMCID: PMC8274802 DOI: 10.1097/gox.0000000000003668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Abstract
Background: Submental fat can be reduced with ATX-101 (deoxycholic acid injection), a customizable and minimally invasive alternative to liposuction. In the years since its approval, the treatment patterns of ATX-101 have evolved. Methods: A panel of experienced physicians from the United States gathered to generate best practices for the use of ATX-101 in submental contouring. Results: The expert panel provided their insights on appropriate patient selection, managing patient expectations of ATX-101 treatment outcomes, and adverse events, and guidance on ATX-101 administration for optimal outcomes are presented here. Conclusion: These best clinical practices on the use of ATX-101 for the reduction of submental fat should enable physicians to enhance the patient treatment experience and outcomes.
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Shridharani SM. Evaluating a Topical Adjunctive Post Submental ATX-101 (Deoxycholic Acid) Injections for Improved Recovery: A Single-Center, Double-Blind, Randomized Controlled Pilot Study. Aesthet Surg J Open Forum 2021; 3:ojab028. [PMID: 34386769 PMCID: PMC8353883 DOI: 10.1093/asjof/ojab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/24/2023] Open
Abstract
Background Optimizing postprocedural recovery and outcomes for patients is the aim for all physicians. TransFORM Body Treatment with TriHex Technology (TFB) is a topical product that aids in the elimination of fat particles created during procedures and the reduction of associated inflammation, thus speeding up postprocedure recovery time. Objectives Evaluation of postprocedural symptoms, signs, and healing following submental deoxycholic acid (DCA) injections in combination with TFB. Methods Participants received 2 treatments of submental DCA injections. Posttreatment 1, every participant received TFB to apply twice daily to the submental area. Follow-up visits included weeks 1, 2, and 4. After week 4, participants discontinued TFB for 30 days before the second treatment. At the second treatment visit, participants were randomized to receive either TFB or a bland moisturizer to apply twice daily with the same follow-up visits as posttreatment 1. Induration measurements, submental fullness grading, and standardized photography were captured at every visit. At all follow-up visits and before treatment 2, investigator assessments and participant assessments were completed. Results Posttreatment 2, investigator assessments of edema and induration decreased in participants using TFB at weeks 1 and 2 compared with the bland moisturizer. Induration measurements objectively showed a statistically significant reduction at week 2 (posttreatment 2) in participants using TFB compared with the bland moisturizer. Furthermore, participants reported less tenderness and soreness in the TFB group over the bland moisturizer. Conclusions Investigator assessments, participant query, and objective induration analyses have demonstrated that the use of TFB post DCA injections may reduce induration, edema, and discomfort associated with this procedure. Level of Evidence: 2
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Affiliation(s)
- Sachin M Shridharani
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Metzger KC, Crowley EL, Kadlubowska D, Gooderham MJ. Uncommon Adverse Effects of Deoxycholic Acid Injection for Submental Fullness: Beyond the Clinical Trials. J Cutan Med Surg 2020; 24:619-624. [PMID: 32755416 DOI: 10.1177/1203475420943270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deoxycholic acid (BELKYRATM, Allergan, Markham, ON, Canada) is a minimally invasive injectable treatment approved by Health Canada for the nonsurgical reduction of submental fullness. Multiple phase III clinical trials have proven the efficacy and safety of deoxycholic acid. In the clinical trials, the most common adverse events (AEs) reported, such as injection site pain, numbness, swelling, bruising and induration, were transient and mild-to-moderate in severity. Additional postmarketing AEs have been reported in the literature. In this study, we reviewed the uncommon reported events and aimed to increase clinician awareness of the potential adverse effects for patient counselling of risks and benefits, identify AEs of procedures that may be performed outside of the medical environment, and identify factors that increase the risk of an adverse event. Beyond the clinical trials, real-world case reports and case series have been reported for the AEs of alopecia, transient neuropraxia, vascular occlusive events/vascular injury, and skin necrosis. Dermatologists need to be aware of these risks, for the treatment and management of their own patients and for those patients who may be treated outside the medical clinic environment that present for medical management of these AEs.
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Affiliation(s)
- Kristy C Metzger
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,6515 Trent University, Peterborough, ON, Canada
| | - Erika L Crowley
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,6515 Trent University, Peterborough, ON, Canada
| | - Dorota Kadlubowska
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - Melinda J Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada.,Queen's University, Kingston, ON, Canada
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