Sodium Deoxycholate for Submental Contouring

Shannon Humphrey, MD, FRCPC, FAAD; Katie Beleznay, MD, FRCPC, FAAD; Jean D. A. Carruthers MD, FRCSC, FRC (OPHTH), FASOPRS


Skin Therapy Letter. 2016;21(5) 

In This Article

Abstract and Introduction


The chin and jaw line are integral parts of an individual's aesthetic profile, and the presence of submental fat detracts from this and can lead to displeasure with one's facial appearance. While liposuction and cosmetic surgery are regarded as the gold standard in treating submental fat, surgical intervention is not appealing to all patients and has potential surgical complications including longer recovery, and contour irregularities. Despite ample advances in aesthetic medicine to enhance the appearance of the face, very little is available in non-invasive options to reduce submental fat that has been supported by robust evidence. ATX-101, a proprietary formulation of deoxycholic acid that is synthetically derived, has been extensively explored in a vigorous clinical development program that has established the safety and efficacy of the injectable. It has recently received approval by regulatory authorities in Canada (Belkyra™) and the US (Kybella®) for the treatment of submental fat.


Desirable features of the face are thought to follow the "golden ratio" or Phi that is seen in natural formations.[1,2] What is viewed as an attractive face in contemporary culture does not significantly differ from ancient times.[3] Think of the bust of Egyptian queen Nefertiti. The ideal face appears as an inverted triangle that contains a wide mid-face that tapers toward the chin.[4,5] A defined chin denotes assertiveness, credibility, and leadership.[6] A face that has aesthetic balance is thought to feature a neck contour that is pleasing to the eye.[7] Individuals who have submental fullness may be perceived as having an unattractive profile of the chin and may experience reduced satisfaction with their appearance which erodes their sense of well-being.[8,9] The presence of submental fat superficially and deep to the platysma muscle is regarded as a sign of aging of the lower face,[10,11] but there are individuals, both young and old, whose morphology involves a round face which includes deposits of submental fat. Still for others, a genetic predisposition produces undesired submental fat that detracts from their profile and remains even with weight loss and exercise.[1,7]

Surgery has been the mainstay to treat submental fullness, colloquially referred to as the "double chin".[8] Complications from surgery however make it somewhat unappealing to patients.[12] Indeed, alternatives to surgery would be well-received by both clinicians and patients.