Expert derm shares injectable adipolysis pearls

Gary D. Monheit, M.D.Neck rejuvenation, an area relatively neglected in the past, has become an obsession among cosmetic surgery patients. And paving the way in the nonsurgical realm is injectable adipolysis with deoxycholic acid, an option that is compatible with the other injectable cosmetic procedures dermatologists use in facial rejuvenation, according to Birmingham, Ala., dermatologist Gary D. Monheit, M.D.

Dr. Monheit was among the panel members presenting during today’s “Neck Obsession: Comprehensive Neck Rejuvenation” session at the 2016 American Society for Dermatologic Surgery (ASDS) annual meeting in New Orleans. His topic: “Injectable Adipolysis – Deoxycholic Acid.”

The best candidates for injectable adipolysis with deoxycholic acid are patients younger than 50, who have double chins caused by excess fat. The worst candidates include older patients with significant laxity and little fat, according to Dr. Monheit.

“[Deoxycholic acid] destroys fat cells and skin retracts creating a younger and more pleasing neck contour. If the lax skin does not contract, there will not be the significant improvement desired. In fact, the lax skin without excess fat can look worse than the original profile,” he tells Dermatology Times. “The younger patient with minimal fat gets the very best results with little discomfort or downtime and only one or two treatments.”

To use injectable adipolysis with deoxycholic acid for neck contouring, dermatologists must understand the anatomy of the neck, chin and jawline.

“This includes positioning of submental fat, location and course of blood vessels and, most importantly, the course of the third division of the facial nerve, at and below the jawline,” Dr. Monheit says. “[When treating patients], it is important not to over-inject in any one area, place the drug too deep or too superficially.”

Armed with this knowledge, dermatologists can locate the pre-platysmal fat to be treated safely and successfully. 

“The physician must be aware of normal side effects and discuss these with the patient. These include swelling, bruising, numbness and some tenderness that may last for two to five days,” he says. “The side effects are related to the amount of fat treated. The side effect of facial nerve paresis is very rare, reversible and avoidable if one is aware of the anatomy.

Dr. Monheit suggests that neck contouring should be one part of a facial-neck rejuvenation program.

“For neck contraction, deoxycholic acid injections can be combined with laser or ultrasonic skin tightening,” he says. “Skin texture and color should be approached with cosmeceutical products, as well as selective lasers. Lower face contouring also will improve the neck contour with augmenting the chin and jawline using fillers and botulinum toxin for platysmal cords and jawline contouring.”

Appropriate patient selection is paramount for optimal outcomes and limiting side effects.

The consultation, according to the dermatologist, can give patients realistic expectations and eliminate patients who need more than injectable adipolysis with deoxycholic acid will deliver.

Disclosure: Dr. Monheit is a consultant and clinical investigator for Kythera and Allergan.