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Can’t seem to shift your double chin?

Can’t seem to shift your double chin?

Treating submental fullness – treatment options and are you a candidate?

The submental area is an area that causes a lot of people to worry about their appearance. Some complaints I hear in the clinic are – “I saw my profile in a photo and HATE my double chin”, or “I work out and eat a healthy diet, but I can’t seem to shift this pocket of fat!”

Concerns about the appearance of this area can contribute to a lack of confidence, concerns about looking older, or appearing unhealthy. So, if this sounds like you, you’re not alone! There are as many people concerned by the area under their chin as there are by fine lines and wrinkles.

When it comes to treating this area, you have a few options. They fall into surgical and non-surgical procedures. Surgical options include liposuction or a neck lift, and while these offer excellent and permanent results, some people do not wish to have surgery.

Non-surgical techniques to address this area include injectables (which I’m going to cover in more detail here!), or the use of energy-based devices (such as HIFU or RF) to reduce the appearance of submental fat.  

Let’s delve into fat-dissolving injections…

The product used in this injectable treatment is called deoxycholic acid. This is a non-human, non-animal form of deoxycholic acid, which is a naturally occurring substance in the body that helps break down and reabsorb fat. It works by breaking down the fat cells in the pre-platysmal area under the chin. This causes an inflammatory reaction, with the recruitment of white cells and macrophages which naturally clear the break-down products from the body. There is also an added benefit of the deoxycholic acid triggering the skin to create collagen, and so throughout the recovery phase after treatment, your skin will become tighter and smoother.

This procedure is indicated for the treatment of moderate to severe submental fullness or convexity associated with submental fat in adults – i.e., a moderate or severe “double-chin”.

A scale for grading the severity of submental fullness with a description and images of the degrees of severity.

There are a few caveats to treatment though…the skin quality and elasticity in this area must be good otherwise the treatment outcome will be poor, and the treatment has minimal benefit in those of you with mild or very severe fullness to this area. There are a few other considerations that are covered in the pre-treatment consultation, such as the prominence and strength of your neck muscles, the position of your hyoid bone, and any previous cosmetic treatment in the neck/submental region.

How is the treatment done?

As already stated, the treatment is via injections to the submental area which is carried out after a careful planning phase. The planning phase involves assessing the amount and location of the submental fat that is the target of treatment, mapping out the treatment area (including “no-go” zones and anatomical markings) and drawing up the correct dosing for treatment.

Deoxycholic acid is then injected into the fatty deposits under the skin where its MOA is to destroy the fat cells – this is permanent!

What to expect:

Most people require between 2-4 treatments, with each treatment spaced at least 4 weeks apart.

Once the desired results are achieved after treatment the great news is that the results last >5 years and many people do not require re-treatment (due to MOA being the destruction of fat cells).

It is really important to note that the planning phase should counsel you about the need for repeated treatment, but once this is completed and the result is achieved, no further treatments are required.


Who is a candidate?

BMI less than 30

No sagging skin, skin must have good elasticity

18-65 years old, males and females

Not in pregnancy or breastfeeding

Contraindications – Allergy, infection in the treatment area

What are some potential complications of treatment?

The usual bleeding, bruising, and swelling we expect with any injectable treatment is no different with deoxycholic acid. 

The most common side effects of treatment are bruising and swelling to the treatment area, and pain at the site of injection. 

A note on the swelling – there can be significant swelling for up to 8 days after the treatment. This is down to how deoxycholic acid is working to break down and then clear the fat cells from the body. Once injected, deoxycholic acid causes fat cell destruction which triggers a response from your immune system to target and clear the products released from the treatment process. So, the swelling is a normal part of treatment, but one to be fully aware of PRIOR to having your first session!

Subsequent sessions are also much better tolerated, with less swelling and pain when compared to the initial treatment.

Other complications of treatment include…

Nerve injury to a nerve that runs along your jawline. Injury to this nerve causes an asymmetrical smile. This is not a permanent injury and happens very rarely but highlights the importance of proper treatment planning!

Poor injection techniques can also cause skin ulceration and necrosis, again, this isn’t permanent but takes some time to heal.

So, what are the results like?

36yo male, before and after deoxycholic acid injections for the submental area or double chin
46yo female, before and after deoxycholic acid injections for the submental area or double chin

The cost per treatment is based on your individualized dose, typically you need 2 vials per treatment and 2-4 treatments are usually required. 

Please note that this is subject to your individual assessment and results can vary.

If you’re interested in having a consultation to assess your suitability for this treatment, get in touch!

Masters in Clinical Dermatology Dissertation. This PDF download is provided for personal use and is the intellectual property of Dr. Sarah Tranter  and Dr. Tranter Aesthetics. It cannot be copied or reproduced without permission.

The Efficacy and Safety of Topical Retinoids for preventing and reversing the effects of photoageing (pdf)

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