ASDS GUIDELINES OF CARE FOR TUMESCENT LIPOSUCTION

Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol-Ketamine Protocol

BACKGROUND

Over the past 4 years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants-true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol-ketamine protocol, which is proposed as a potentially safe alternative.

METHODS

The retrospective analysis covered 8 years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol-ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation.

RESULTS

Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed.

CONCLUSIONS

The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol-ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients.

LEVEL OF EVIDENCE IV

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 .

Effect of Liposuction on Body Weight and Serum Concentrations of Leptin, Lipids, Glucose, and Insulin: A Meta-Analysis

BACKGROUND

Abdominal obesity has been associated with an increased risk of insulin resistance, metabolic syndrome, and diabetes. Central fat removal procedures such as liposuction, lipectomy, and abdominoplasty are among the most common surgical procedures. The impact of the latter on the former is controversial and understudied. The authors aimed to explore the effect of subcutaneous fat elimination procedures on insulin resistance measures and adipokine levels.

METHODS

Relevant studies regarding the effects of surgical subcutaneous fat removal on glucose, insulin, adipokines, and lipid metabolism, as well as blood pressure, were identified by searching PubMed and Ovid-Cochrane without limits in date, type of publication, or language. After the selection process, 24 studies were obtained. The results of the articles were summarized using descriptive statistics. For the final analysis, a randomized effects model was used to evaluate heterogeneity; averages and meta-analytic differences were expressed with a confidence interval of 95%.

RESULTS

All studies reported a reduction in weight (-2.64 kg; 95% CI, -4.32 to -0.96; P = 0.002; I 2 = 36%; P of I 2 < 0.001) and body mass index after liposuction. A significant improvement in triglycerides (-10.06 mg/dL; 95% CI, -14.03 to -6.09; P < 0.001; I 2 = 48%; P of I 2 = 0.05), serum glucose concentration (-4.25 mg/dL; 95% CI, -5.93 to -2.56; P < 0.001; I 2 = 68%; P of I 2 < 0.001), serum insulin concentration (-2.86 μIU/mL; 95% CI, -3.75 to -1.97; P < 0.001; I 2 = 59%; P of I 2 = 0.003), and serum leptin concentration (-7.70 ng/mL; 95% CI, -11.49 to -3.92; P = 0.0001; I 2 = 96%; P of I 2 < 0.001) was consistently observed.

CONCLUSION

In addition to weight loss, there is a significant decrease in leptin, triglyceride, glucose, and insulin serum concentrations after liposuction, a fact that should be considered in future discussions.

Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature

BACKGROUND

Minimally invasive cosmetic procedures are on the rise. To meet this rising demand, increasing numbers of physicians and nonphysicians are performing these procedures. Understanding malpractice trends and reasons for litigation in cosmetic medicine is important to establish safeguards for patient care and minimize liability.

OBJECTIVE

Perform a comprehensive review of the literature on litigation associated with minimally invasive cosmetic procedures and discuss strategies to avoid facing a lawsuit.

MATERIALS AND METHODS

The authors searched PubMed databases using a variety of keywords to identify studies of lawsuits arising from minimally invasive cosmetic procedures through December 2020.

RESULTS

A total of 12 studies of litigation meeting inclusion criteria were identified: botulinum toxin (1), soft tissue fillers (3), lasers (5), body contouring/liposuction (1), chemical peels/dermabrasion (1), and sclerotherapy (1). Principle factors associated with litigation included negligence, lack of informed consent, vicarious liability for action of delegates, lack of communication, poor cosmetic result, failure to inform of risks, inappropriate treatment or dose, and failure to recognize or treat injury.

CONCLUSION

Understanding malpractice trends and reasons for litigation in minimally invasive cosmetic procedures can strengthen the patient-provider relationship, establish safeguards for patient care, and may minimize future risk of a lawsuit.

Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples

BACKGROUND

Autologous fat is known for a reliable and natural safety profile, but complications do occur-even serious vascular adverse events.

OBJECTIVES

The authors sought to examine doppler-ultrasound (DUS) imaging for the harvesting and subsequent facial implantation of autologous fat tissue.

METHODS

All patients underwent lipofilling treatment of the temporal fosse of the face. DUS examination was performed for preprocedural vascular mapping and imaging of previously injected (permanent) fillers. In addition, the injection of autologous fat was performed DUS-guided.

RESULTS

Twenty patients (all female; mean age, 57.9 years; range, 35-64 years). DUS examination showed that 16 of the 20 patients (80%) had been injected with resorbable or nonresorbable fillers elsewhere in the past. The temporal artery could be visualized and avoided in all cases. An average of 1.1 cc of autologous fat was injected in the temporal fossa per side. One case of edema and nodules was described, but no other adverse events were reported.

CONCLUSIONS

The utilization of DUS can add valuable information to a lipofilling procedure and should be considered an integral part of a safe lipofilling treatment.

LEVEL OF EVIDENCE: 4

Three-step tumescent local anesthesia technique for inguinal hernia repair

The optimal method of anesthesia for inguinal hernia repair is still controversial. We have developed "three-step tumescent local anesthesia (TLA) technique" for inguinal hernia repair, and recently showed that this technique is acceptable in view of short- and long-term clinical outcomes. Our study included 273 consecutive cases (290 sides) of elective inguinal hernia repair performed under the newly developed technique between September 2003 and May 2019, and overall clinical outcomes were considered to be safe and feasible. Herein, we report the surgical procedure of "three-step TLA technique." Briefly, we rapidly inject the diluted solution of local anesthetic and epinephrine step-by-step into the three following closed tissue space. Initially, 80 mL injection into the subcutaneous tissue before skin incision (Step 1). After the external oblique fascia is exposed, injection of 20 mL into the inguinal canal before the external oblique fascia is incised and opened (Step 2). The hernia sac and spermatic cord are then dissected, and the blunt dissection of the preperitoneal space is made by injecting 20 mL under the internal inguinal ring (Step 3), followed by placing a gauze into the preperitoneal space, creating the space for mesh placement. We consider that the most important point of this technique is achieved through the rapid injection of TLA solution into each closed tissue space, which makes for easier dissection, hemostasis, and good pain control.

Plastic Surgery Complications: A Review for Emergency Clinicians

The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.

Tumescent Local Infiltration Anesthesia for Mini Abdominoplasty with Liposuction

AIM:

To evaluate the feasibility and safety of mini abdominoplasty with liposuction under local tumescent anaesthesia (LA) as the sole anaesthetic modality.

METHODS:

The study included 60 female patients with a mean age of 33.3 ± 5.6 years. Local infiltration using a mixture of 1:1000 epinephrine (1 ml), 2% lidocaine (100 ml) and 0.5% Levobupivacaine (50 ml) in 2500 ml saline was started with Local infiltration started with the abdomen, outer thigh, hips, back, inner thighs and knees. After Mini Abdominoplasty with supplemental liposuction was conducted and application of suction drains wound closure was performed, and the tight bandage was applied. Pain during injection, incision and surgical manipulations was determined. Duration of postoperative analgesia, till oral intake and return home, patients and surgeon satisfaction scores were determined.

RESULTS:

All surgeries were conducted completely without conversion to general anaesthesia. Injection pain was mild in 46 patients, moderate in 10 and hardly tolerated in 4 patients. Incision pain was mild in 16 patients, while 44 patients reported no sensation. During the surgical procedure, 6 patients required an additional dose of LA. Meantime till resumption of oral intake was 1.6 ± 0.9 hours. Meantime till home return was 5.6 ± 2.4 hours. Twelve patients were highly satisfied, 18 patients were satisfied, and these 42 patients were willing to repeat the trial if required. Eight patients found the trial is good and only one patient refused to repeat the trial and was dissatisfied, for a mean total satisfaction score of 3.1 ± 0.9.

CONCLUSION:

Mini Abdominoplasty with liposuction could be conducted safely under tumescent LA with mostly pain-free intraoperative and PO courses and allowed such surgical procedure to be managed as an office procedure. The applied anaesthetic procedure provided patients’ satisfaction with varying degrees in about 97% of studied patients.

Local anesthetic systemic toxicity: current perspectives

Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and one-fifth of the reported cases present with isolated cardiovascular disturbance. There are several risk factors that are associated with the drug used and the administration technique. LAST can be mitigated by targeting the modifiable risk factors, including the use of ultrasound for regional anesthetic techniques and restricting drug dosage. There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.

[Liposuction]

Liposuction began in the 1920s when the Parisian surgeon Charles Dujarier became interested in body shaping and fat removal. Today, it is estimated that 1,453,000 liposuctions are annually performed worldwide. In Germany, 45,000 liposuctions are performed annually. The majority of liposuctions are performed as self-pay services. The aim of this article is to outline the development of liposuction, to explain the various liposuction procedures and methods, to clarify the indications for treatment, and point out the complications and pitfalls described in the literature.

Low-Level Laser Therapy for Reducing the Hip, Waist, and Upper Abdomen Circumference of Individuals with Obesity

OBJECTIVE

To assess the effectiveness of low-level laser therapy (LLLT) for reducing hip, thigh, and abdomen circumference of individuals with body-mass index (BMI) between 30 and 40 kg/m².

BACKGROUND

Previous studies demonstrated the effectiveness of LLLT for reducing body circumference in the hips, thighs, and abdomen of nonobese individuals with a BMI <30 kg/m².

METHODS

In this randomized, double-blind sham-controlled study, obese, but otherwise healthy, individuals were randomized to undergo 30-min LLLT (n = 28) or sham treatments (n = 25) three times weekly for 4 weeks. Body measurements were obtained after 2 and 4 weeks of treatment and 2 weeks post-treatment ( ClinicalTrials.gov Identifier: NCT01821352).

RESULTS

After 4 weeks, 20 LLLT-treated subjects (71.43%) achieved ≥7.2 cm decrease in combined measurements versus three sham-treated subjects (12%; p < 0.00005). The mean (standard deviation) decrease in combined measurement for LLLT-treated subjects was 10.52 (7.59) cm (p < 0.0001 vs. baseline) versus 1.80 (3.20) cm for sham-treated subjects. Among subjects with a combined ≥7.2 cm decrease, the mean total decrease 2 weeks post-treatment was 15.21 cm. There were no adverse events.

CONCLUSIONS

Based on these results, the device was cleared by the U.S. Food and Drug Administration as a noninvasive esthetic treatment for reduction of circumference of hips, waist, and upper abdomen when applied to individuals with a BMI between 30 and 40 kg/m².

Estimated Maximal Safe Dosages of Tumescent Lidocaine

Supplemental Digital Content is available in the text.

Published ahead of print February 18, 2016

BACKGROUND:

Tumescent lidocaine anesthesia consists of subcutaneous injection of relatively large volumes (up to 4 L or more) of dilute lidocaine (≤1 g/L) and epinephrine (≤1 mg/L). Although tumescent lidocaine anesthesia is used for an increasing variety of surgical procedures, the maximum safe dosage is unknown. Our primary aim in this study was to measure serum lidocaine concentrations after subcutaneous administration of tumescent lidocaine with and without liposuction. Our hypotheses were that even with large doses (i.e., >30 mg/kg), serum lidocaine concentrations would be below levels associated with mild toxicity and that the concentration-time profile would be lower after liposuction than without liposuction.

METHODS:

Volunteers participated in 1 to 2 infiltration studies without liposuction and then one study with tumescent liposuction totally by local anesthesia. Serum lidocaine concentrations were measured at 0, 2, 4, 6, 8, 10, 12, 14, 16, 18, and 24 hours after each tumescent lidocaine infiltration. Area under the curve (AUC∞) of the serum lidocaine concentration-time profiles and peak serum lidocaine concentrations (Cmax) were determined with and without liposuction. For any given milligram per kilogram dosage, the probability that Cmax >6 μg/mL, the threshold for mild lidocaine toxicity was estimated using tolerance interval analysis.

RESULTS:

In 41 tumescent infiltration procedures among 14 volunteer subjects, tumescent lidocaine dosages ranged from 19.2 to 52 mg/kg. Measured serum lidocaine concentrations were all <6 μg/mL over the 24-hour study period. AUC∞s with liposuction were significantly less than those without liposuction (P = 0.001). The estimated risk of lidocaine toxicity without liposuction at a dose of 28 mg/kg and with liposuction at a dose of 45 mg/kg was ≤1 per 2000.

CONCLUSIONS:

Preliminary estimates for maximum safe dosages of tumescent lidocaine are 28 mg/kg without liposuction and 45 mg/kg with liposuction. As a result of delayed systemic absorption, these dosages yield serum lidocaine concentrations below levels associated with mild toxicity and are a nonsignificant risk of harm to patients.

Current status of surgery in dermatology

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

Tumescent anaesthesia

Tumescent anaesthesia describes the practice of injecting a very dilute solution of local anaesthetic combined with epinephrine and sodium bicarbonate into tissue until it becomes firm and tense (tumescent). It was initially described in the field of liposuction but now surgical applications for the technique are widely varied ranging across vascular surgery, breast surgery, plastic surgery and ENT procedures. It is widely used in both hospital- and office-based environments and may form the sole method of anaesthesia for surgery. Advantages include a reduction in blood loss through both epinephrine-induced vasoconstriction as well as hydrostatic compression from the tumescent effect. Sodium bicarbonate reduces pain associated with the injection of an acidic local anaesthetic solution. Due to the unique pharmacokinetic profile of this technique lidocaine doses of 35 mg/kg bodyweight have been shown to be safe for liposuction procedures. Tumescent lidocaine is absorbed very slowly from subcutaneous tissues producing lower, and more delayed, peak blood levels compared to other routes, as well as extended postoperative analgesia. Slow systemic absorption allows the rapid hepatic plasma clearance of lidocaine to maintain safe local anaesthetic blood levels. This slow absorption from subcutaneous tissue has been likened to a depot injection. Careful attention must be given to appropriate local anaesthetic dosage alterations in cases of co-administration with agents affecting hepatic drug clearance or conditions reducing liver blood supply. Adherence to these pharmacological principles has produced an exemplary safety record for this technique to date.

Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring

BACKGROUND

Excess body fat, localized adiposity, and cellulite represent important social problems. To date, techniques using radiofrequencies, cavitation and noncavitation ultrasound, and carbon dioxide have been studied as treatments for noninvasive body contouring. Ice-Shock Lipolysis is a new noninvasive procedure for reducing subcutaneous fat volume and fibrous cellulite in areas that normally would be treated by liposuction. It uses a combination of acoustic waves and cryolipolysis. Shock waves, used normally in the treatment of renal calculi and musculoskeletal disorders, are focused on the collagen structure of cellulite-afflicted skin. When used on the skin and underlying fat, they cause a remodeling of the collagen fibers, improving the orange-peel appearance typical of the condition. Cryolipolysis, on the other hand, is a noninvasive method used for the localized destruction of subcutaneous adipocytes, with no effects on lipid or liver marker levels in the bloodstream. The combination of the two procedures causes the programmed death and slow resorption of destroyed adipocytes.

METHODS

In this study, 50 patients with localized fat and cellulite were treated with a selective protocol for the simultaneous use of two transducers: a Freezing Probe for localized fatty tissue and a Shock Probe for fibrous cellulite.

RESULTS

The procedure significantly reduced the circumference in the treated areas, significantly diminishing fat thickness. The mean reduction in fat thickness after treatments was 3.02 cm. Circumference was reduced by a mean of 4.45 cm. Weight was unchanged during the treatment, and no adverse effects were observed. Histologic and immunohistochemical analysis confirmed a gradual reduction of fat tissue by programmed cell death. Moreover, the reduction in fat thickness was accompanied by a significant improvement in microcirculation, and thus, the cellulite. The safety of the method also has been highlighted because it is accompanied by no significant increase in serum liver enzymes or serum lipids.

CONCLUSION

The study aimed to observe the effects of the new technique in the treatment of localized fat associated with cellulite in order to assess adipose tissue alterations, cellular apoptosis, and levels of serum lipid or liver markers. The findings show that the action of Ice-Shock Lipolysis is a safe, effective, and well-tolerated noninvasive procedure for body contouring. In particular, the authors believe that this could be an ideal alternative to liposuction for patients who require only small or moderate amounts of adipose tissue and cellulite removal or are not suitable candidates for surgical approaches to body contouring.

Noninvasive body sculpting technologies with an emphasis on high-intensity focused ultrasound

BACKGROUND

Body-sculpting procedures are becoming increasingly popular in the United States. Although surgical lipoplasty remains the most common body sculpting procedure, a demand exists for noninvasive alternatives capable of reducing focal adiposity without the risks of adverse events (AEs) associated with invasive excisional body-sculpting procedures.

METHODS

This report describes the mechanism of action, efficacy, safety, and tolerability of cryolipolysis, radiofrequency ablation, low-level external laser therapy, injection lipolysis, low-intensity nonthermal ultrasound, and high-intensity focused ultrasound (HIFU), with an emphasis on thermal HIFU. The articles cited were identified via a PubMed search, with additional article citations identified by manual searching of the reference lists of articles identified through the literature search.

RESULTS

Each of the noninvasive treatments reviewed can be administered on an outpatient basis. These treatments generally have fewer complications than lipoplasty and require little or no anesthesia or analgesia. However, HIFU is the only treatment that can produce significant results in a single treatment, and only radiofrequency, low-level laser therapy, and cryolipolysis have been approved for use in the United States. Early clinical data on HIFU support its efficacy and safety for body sculpting. In contrast, radiofrequency, laser therapy, and injection lipolysis have been associated with significant AEs.

CONCLUSIONS

The published literature suggests that noninvasive body-sculpting techniques such as radiofrequency ablation, cryolipolysis, external low-level lasers, laser ablation, nonthermal ultrasound, and HIFU may be appropriate options for nonobese patients requiring modest reduction of adipose tissue.

Safety of tumescent liposuction under local anesthesia in a series of 4,380 patients

BACKGROUND

Liposuction is increasingly performed under local anesthesia and in an outpatient setting. The term 'tumescent liposuction' has been used in the literature in patients receiving other forms of anesthesia as well, hence the confusion regarding the safety profile of liposuction performed under local anesthesia alone.

OBJECTIVE

To analyze the safety of tumescent liposuction performed under local anesthesia in a larger group of patients.

METHODS

Between 2003 and 2010, 4,380 consecutive patients underwent tumescent liposuction by the same surgeon. The occurrence of complications was recorded in detail.

RESULTS

There were no serious complications requiring hospitalization. There were no injuries, no nerve damage or permanent lymphedema, no deep venous thrombosis or seroma. Seven patients needed closer follow-up due to large hematoma (n = 3; no drainage needed), allergic drug reaction to doxycycline (n = 2), erysipelas (n = 1) and generalized edema (n = 1).

CONCLUSIONS

Tumescent liposuction under local anesthesia is a safe method, providing it is performed by an experienced surgeon and the guidelines of care for liposuction are strictly followed.

Tumescent local anesthesia for excision and flap procedures in treatment of pilonidal disease

PURPOSE

We describe our experience with tumescent local anesthesia for excision and flap procedures in the treatment of pilonidal disease.

METHODS

Forty consecutive patients with symptomatic pilonidal disease were treated. Tumescent solution was prepared by mixing one volume of a lidocaine (20 mg/ml) and adrenaline (0.0125 mg/ml) combination with 9 volumes of lactated Ringer's solution. The final solution was infiltrated gradually and liberally, first subcutaneously and then into the skin. The end point was swollen and firm skin. After excision, the area was filled with an advancement flap or a rotational flap.

RESULTS

The study group consisted of 37 men (92.5%) and 3 women (7.5%); mean age, 27 (range, 18-61) years. The amount of injected solution ranged from 60 mL to 140 mL (mean, 100 mL; dose interval, 2-4 mg/kg). No additional anesthesia or sedation was needed, and no complications were observed during the procedure. Half of the patients were discharged on the day of the operation, half on the next day. Follow-up ranged from 13 to 37 months. Patients returned to daily activities after a mean of 10.5 (range, 2-30) days. Primary healing occurred uneventfully in 28 patients (70%); wound healing complications occurred in 12 (30%). No flap necrosis was observed. Thirty-seven (92.5%) patients reported satisfaction with the procedure. Recurrence was observed in 3 patients (7.5%).

CONCLUSIONS

Excision and flap procedures for sacrococcygeal pilonidal disease can be performed under tumescent local infiltration anesthesia with acceptable results, without requiring regional or general anesthesia.

Randomized double-blind clinical trial of subcutaneously injected deoxycholate versus a phosphatidylcholine-deoxycholate combination for the reduction of submental fat

BACKGROUND

Subcutaneous injections consisting of the detergent, sodium deoxycholate, alone or in combination with the phospholipid, phosphatidylcholine, have been reported to reduce adipose tissue. The role of phosphatidylcholine remains unclear.

OBJECTIVE

To evaluate the safety profile and efficacy of subcutaneously injected deoxycholate alone compared with a conventionally utilized mixture of phosphatidylcholine/deoxycholate in patients with undesirable accumulations of submental fat.

METHODS

This was a single center, randomized, double-blind exploratory study. A total of 42 subjects were enrolled; 28 were injected into the submental fat with 1 mL of deoxycholate or phosphatidylcholine/deoxycholate, and 14 received 2 mL per treatment. Subjects received up to 5 treatments every four weeks, and completed a home diary and post-treatment self-assessment. Clinicians blinded to treatment performed injections, physical examination, and photographic evaluation.

RESULTS

Photographic assessment of 32 of the 42 enrolled patients revealed modest changes in submental profiles after a median of 5 deoxycholate or 4 phosphatidylcholine/deoxycholate treatments. Mean degree of improvement (0=none, 1=mild, 2=moderate, 3=significant) was 0.8 (+/-0.9) for deoxycholate and 0.6 (+/-0.5) for phosphatidylcholine/deoxycholate, with a median improvement of 0.5 (range, 0-3) for both groups. The incidence of correct before:after photographic sequence assignments was similar. There were no notable differences on physical examination, incidence, duration, and severity of adverse events (most commonly edema, erythema, pain, and burning) or subject self-assessment of fat loss, skin tightening, chin profile, and overall performance between the treatments.

CONCLUSION

Under the conditions employed, injections of deoxycholate or phosphatidylcholine/deoxycholate into the submental fat produced minimal aesthetic improvement overall. No apparent differences in efficacy or adverse events were observed with the inclusion of phosphatidylcholine. Enhanced neck profiles in several subjects demonstrate a proof of concept that warrants further study utilizing a validated, submental profile grading scale and methods to optimize dose and technique.