Deoxycholic Acid for Fat Reduction: Safety and Efficacy
Deoxycholic acid (Kybella/Belkyra) is FDA-approved only for submental fat reduction and should not be used for general body fat reduction as its safety and efficacy outside the submental region has not been established. 1
FDA-Approved Indication
Deoxycholic acid (DCA) injection is specifically indicated for:
- Improvement in the appearance of moderate to severe convexity or fullness associated with submental fat ("double chin") in adults
- Not approved for treatment of subcutaneous fat outside the submental region 1
Efficacy for Submental Fat
When used as approved for submental fat:
- Multiple clinical trials demonstrate effectiveness in reducing submental fullness
- Requires multiple treatment sessions (up to 6) spaced at least 1 month apart
- Each treatment consists of multiple small injections (up to 50) of 0.2 mL each
- Effects are generally maintained for at least 2 years after treatment 2
Safety Profile for Approved Use
Common side effects in the submental area include:
- Edema (94.4% of treatments)
- Bruising (90.7%)
- Erythema (79.6%)
- Pain at injection site
- Numbness/anesthesia
- Most side effects are self-limited, resolving within days 3, 4
Serious potential complications include:
- Marginal mandibular nerve injury (causing asymmetrical smile)
- Dysphagia (difficulty swallowing)
- Tissue necrosis if inadvertently injected into blood vessels
- Hair loss at injection sites
- Infection 1, 4
Off-Label Use for Other Body Areas
While some pilot studies have explored DCA for other areas like hypogastric fat:
- Small sample sizes limit conclusions about safety and efficacy
- Similar side effect profile to submental use (edema, bruising, erythema)
- Cost-benefit ratio may be unfavorable for larger fat deposits 3
- No FDA approval exists for these applications
Patient Selection Considerations
DCA is contraindicated in:
- Patients with infection in the treatment area
- Patients with excessive skin laxity (results may be aesthetically undesirable)
- Areas with prominent platysmal bands
- Areas with altered anatomy due to previous procedures 1
Alternative Approaches for General Fat Reduction
For general body fat reduction, guidelines recommend:
- Diet and physical activity as first-line approaches for fat reduction 5
- Bariatric surgery for eligible obese individuals with significant fat deposits 5
- Structured lifestyle programs involving participant education, reduced dietary fat and energy intake, and regular physical activity 5
Conclusion
For patients seeking fat reduction:
- Deoxycholic acid should only be used for submental fat as approved by the FDA
- The treatment requires specialized administration by healthcare professionals
- For general body fat reduction, lifestyle modifications remain the cornerstone of treatment
- Using DCA for fat reduction outside the submental area is not recommended due to lack of established safety and efficacy data