Deoxycholic acid :- Nonsurgical treatment of difficult fat Injection adipolysis !

DR. Tak. Kyoungseok

M.D., Ph.D. President and Chief Surgeon,

TN Plastic and Reconstructive Surgen Hospital Seoul, Karea

Obesity Including local fat Deposit is associated with loss of social visibility, and someone may consider that such appearance may also cause low self-esteem, discomfort and distress.

Surgical procedures such as liposuction was developed about 40 years ago to remove localize fat deposits for improving medical and cosmetic aspects.

However, Surgery is high — priced, often requires general anesthesia, and has the potential for serious medical complications. . it may involve risk of local infection, transmission of pathogens and long-term side effects, such as contour irregularities that may need recovery time of up to 1 year.

So, some patients may be concerned about undergoing an invasive surgery and others may not be suitable for this type of intervention.

Therefore, the use of less invansive, nonsurgical method to reduce localized fat deposits has gained interest. Nowdays nonsurgical minimal invasive methods of cosmetic enhancement have become the new paradigm.

Among them, recent advances in laser and high-frequency focused ultrasound for fat reduction are received attention. But there are insufficient clinical evidences and the use of non-surgical energy-based devices for fat reduction is considered to be as less efficient and safe as conventional liposuction.

An injection lipolytic or adipocytic therapy such as phosphatidylchline (PC), Deoxycholic acid (DCA) injection is safe, effective, and easy to perform in minimally invasive face and body sculpting.

Several investment group have reported the use of this therapy to remove unwanted fat tissue in the body, including double chin, abdomen, things, buttocks, arms, and neck.

Originally, PC is the main constituent of soy beans, is used as a treatment for myocardial ischemia, cerebrovascular disesease, dementia, and fatty liverinduced liver dysfunction. PC has been introduced as low cost, easy to apply, and efficacious alternative to reduce localized fat deposite on the face and body. Because of its effective and efficient feature, PC is used to treat obesity more frequently than previous techniques such as liposuction

Many physicians and esthetics clinics currently use various their own formulations PC/DCA, and various indications have been described in the literature.

But recent several studies have shown that PC alone has no lipolytic or adipolytic activity in conventional PC/DCA formulation. It suggests that DCA is predominantly responsible for the reduction in adipose tissue mass abnd PC does not contribute to clinical efficacy.

Deoxycholic acid(DCA) is a secondary bile acid produced by intestinal bacteria after the release of primary bile acids in the liver.

Due to the fact that bile acides are cholesterol derivatives with detergent properties, bile acids may after the stability of the membrane lipid bilayer. In fact. Bile acids with increased hydrophobicity bile acids have a marked effect on membrane structure and activation of intracellular signaling.

If the human tissue, especially fat tissue is exposed to DCA, it induce pores in Cellular membranes, producing leakage of cytoplasmic contents, membrane destabilization, and subsequent lysis. These lytic effects occur within minutes 12 and account of the brisk, localized inflammatory response after injection.

The local inflammatory response that is induced by adipocytolysis is responsible for the clearance of cellular debris and removal of breakdown products.

Virtually all patient in treatment experience one of more episodes of swelling, erythema, pain burning, or tenderness at the injection site. Swelling, erythema, and pain or burning typically occurred immediately (within 5 minutes) after each injection and peaked between 24 and 48 hours after injection. Numbness often had an onset several days after the injection and persisted up to 2 weeks. Nodularity (fibrosis) after

Injection Results from their necrotic effects. Replacement of grossy injured fat tissue with fibrosis may account for subsequent fat reduction and skin retraction.

Because it causes to callogenesis (remodeling), DCA treatment is not associated with an undesirable increase in skin laxity.

In relatively protein binding. DCA does not accumulate at the injection site and is site and is absorbed rapidly and removed through protein binding. And there is no adverse effects on complete blood counts. Chemistries, and serum lipids.

DCA previously has shown to be effective for reductions of human lipomas, abdominal fat and hip fat and submental fat.

Especially DCA has been demonstrated the efficacy and acceptable tolerability in phase 1st and 2nd studies for the reduction of subcutaneous fat. The injectable adipolytic DCA is the first nonsurgical treatment for subcutaneous reduction to undergo comprehensive clinical evaluation in a large sample of patients. And the results of several phase3 studies demonstrated that DCA was effective based on Clinician, patient, and objective measure and was well tolerated. It means that DCA may provide a relatively simple injectable approach the removing of unwanted local fat accumulation.

Kythera Biopharmacutics Inc. (Westlake Village, California) investigate a pharmaceutical formulation of synthetic DCA, ATX-101, as an injectable drug of contouring the submental area by reducing fat. And “Kybella” is a first injectable agent approved by US food and Drug Administration (FDA) for the treatment of submental fullness.

DCA Represents an effective and well-tolerated, minimally invasive injectable means of reducing unwanted substaneous fat in patients who are either unsuitable or unwilling to usdergo extensive surgery.

The IDEA of having a nonsurgical, minimal invansive treatment for those patients who wish to remove fat deposit is certainly very attractive. This new treatment can provide opportunities for the many patients to improve the appearance of their fat deposit to have access to a safe, reliable treatment.

DCA injection had positive effects on psychological quality of life, resulting in significant patient satisfaction with treatment and appearance in association with face and body.

However, patients need to be aware that it may take Several months to achieve desired results and there may be adverse events, essentially, such as pain, swelling, erythema and so on.

Above all, physicians shoul be familiar with anatomy and adverse side effects associated with DCA to achieve optimal outcome and patient satisfaction

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