Management of Serious Adverse Events Following Deoxycholic Acid Injection for Submental and Jowl Fat Reduction: A Systematic Review and Management Recommendations

This systematic review addresses the management of serious adverse events (SAEs) following the use of ATX-101 for submental and jowl fat reduction. While Phase 3 trials showed a favorable safety profile, real-world applications have reported avoidable, procedure-related SAEs. The review suggests that management of these events often relies on the discretion of aesthetic surgeons, with some protocols being overly cautious. Recommendations include investigating other causes of fat accumulation, accurately demarcating treatment areas, and assessing fat pad thickness to optimize treatment cycles. Surgery is recommended for jowling due to compartment displacement, while ATX-101 is contraindicated for jowling from tissue atrophy. Preventative measures include avoiding intradermal injections, using lidocaine to check nerve proximity, deeper injections in males to prevent alopecia, maintaining aseptic techniques, using correctly labeled syringes, and confirming diagnoses before treatment.