The drug designed to treat “submental fat” (the fat pocket under the chin) is a new cosmetic injectable, which promises to dissolve fat cells through a series of injections. There’s very little downtime, it’s non-invasive and non-surgical, and there’s little risk. The drug is the first (and only) injectable designed to contour away the dreaded double chin.
Approved by the FDA in 2015, Kythera Biopharmaceuticals’ drug (which has since been acquired by Allergan) hit the market as an alternative to liposuction or surgery, using a synthetic version of deoxycholic acid—a salt found in human bile that aids fat digestion—to destroy fat cells. In the digestive tract, deoxycholic acid breaks down fat by destroying the cell membrane. When injected into subcutaneous fat, this cytolytic drug does the same thing—in targeted locations. The dissolved fat is now cellular debris, and gets cleared into the lymphatic and circulatory systems by specialized immunologic cells. This happens gradually over the span of several weeks. As for the deoxycholic acid, it follows the same path; it gets metabolized and broken down, and then excreted as waste.
The origins of chemical fat-dissolving (a.k.a. mesotherapy) go back to France in the 50s. By the 60s, Allergan’s executive director of medical affairs, European scientists started using a compound called phosphatidylcholine to break up fat for medical reasons. After a patient experiences trauma, perhaps from a fracture, tiny globs of fat can enter the circulation. “And often times they’ll end up in the lungs and can cause respiratory issues,” explains Gallagher. “So, they’re looking for a way to disrupt fat, to help fix that or to treat that. They were using phosphatidylcholine as a potential agent to try and dissolve that fat.” Cut to 1980s Europe, and cosmetic researchers started looking at the compound, thinking, If it can dissolve fat in the vessels, maybe it can dissolve fat elsewhere, says Gallagher. Bodybuilders began injecting themselves with “PC/DA” (a combination of phosphatidylcholine and deoxycholic acid) off-label to get rid of fat pockets for competition.
In the early 2000s, researchers at UCLA discovered that the fat breakdown caused by the PC/DA compound was actually due to the deoxycholic acid—the active ingredient in lipolysis injection. And now here we are.
As women hit 30s, you begin to feel a bit bothered by the so-called double chin. While not especially noticeable, this little pocket of submental fat has been a part of my profile for as long as I can remember; it’s genetic. I’ve often wished it gone, but I never considered a surgical fix. That seemed like an extreme measure for something that’s merely an annoyance in my life. I never saw myself getting any kind of cosmetic procedure at all. Then I saw a magazine ad for a new injectable, non-invasive double-chin treatment.
Anxious about being injected many, many times under the chin (the average patient receives 20 or more injections per treatment), I arrived at the “beauty lab.” It’s the kind of chic place you’d imagine one would visit for such a procedure, with futuristic light fixtures, high-end products on display, and luxe gold accents. It feels less like a medical environment and more like an upscale boutique, complete with a velvet couch. The young women staffing Alchemy 43 sport impeccable makeup and totally smooth faces—a look I don’t often see in my life as a stay-at-home mom and writer on the relaxed east side of Los Angeles. Other services offered by Alchemy 43 include wrinkle relaxing, fillers, sculpting, and lash enhancement, and I imagine for a minute what it would be like to have the time and money to get all these treatments. I would never be able to keep up; I don’t even get my hair cut more than once or twice a year.
For each treatment, the injector uses between one and three vials, depending on how much submental fat one has. According to a dermatologist the cost for a single treatment ranges from £150 to £800, depending on how many vials you need, and the particular pricing of your doctor or spa. The cost can exceed that of liposuction (which generally runs between north of £3000), but many clients are willing to pay a higher price to avoid going under the knife. Previously, the only procedure that was available to treat submental fullness was surgical liposuction, which is an invasive procedure with its own inherent risks and benefits.
The process can be relatively slow, with results taking weeks or more often, months. This can be discouraging, especially to people who are self-conscious about their chins to begin with. The good news is that once your months-long process is completed, those fat cells are not coming back. There is no upkeep to consider, or future costs. You take those fat cells away, they won’t re-create themselves. Safety studies have been done on the long-term results, and in general, between 75 and 90 percent of patients are still maintaining their response at up to five years. Also note that most patients really turn a corner after the second treatment, seeing a noticeable reduction in fat.
Lipolysis injection could be used on various other small areas. From a clinical standpoint, Allergan is looking at the “bra fat” area—the roll of fat that can be present under the bra line or between the bra and the armpit—and the jowl. Sometimes that’s just skin laxity, but there are times when that’s due to fat, as well … so we are certainly actively considering whether we would go into a clinical program there, looking at jowl fat. This type of practice is already being studied in the anterior bra-fat area and upper knees. So although larger areas have been ruled out (an ample stomach, for instance, would need too much product and would require too many needles), whether other small pockets of fat could be helped. Studies would be needed before use on these other areas would be approved by the FDA.
You can start to notice a reduction after about two weeks. The second treatment is often the turning point, the experts tell me, and is optimistic that you won’t need a third go. Lidocaine numbing injections plus the lipolysis shots for the second treatment, and the increased volume caused more swelling. Overall, the second treatment was a little more painful than the first, and I experienced more bruising. One thing I’ve noticed while scrutinizing profile photos through the lipolysis journey: Perhaps there wasn’t much of an issue to begin with! Maybe that softness in facial profile is more common than we realize.