Dermal Fillers Restore Youthful Facial Movement, Don't Just Fill Wrinkles

A strong, well-defined chin and jawline are common trademarks of a youthful appearance, so it's little surprise that as people age and accumulate excess fat in the lower face and neck – creating the appearance of jowls – that patients cite this lack of definition as a common aesthetic concern.

The most common approach to reshaping one's jawline and removing jowls is liposuction. In fact, physician survey data from 2012 found that liposuction was used in 81 percent of jowl fat reduction procedures; however, a new study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), evaluated the efficacy and safety of ATX-101 (deoxycholic acid injection), a minimally invasive treatment approved for submental fat reduction, as a new treatment method for reducing jowl fat without the need for surgery and liposuction.

The study's author, Dr. Sachin M. Shridharani, analyzed his experience with injection lipolysis using ATX-101 in 66 patients seeking treatment for jowl fat causing loss of jawline definition – one of the hallmarks of facial aging. The patients were 38 women and 28 men, average age 46 years. One-half of the patients had undergone previous cosmetic procedures.

Eligible patients had pinchable fat on the jawline and relatively minimal skin laxity in the jowl. Depending on the size of the treatment area, ATX-101 injections of 0.2 ml spaced 1.0 cm apart or 0.1 ml spaced 0.50 to 0.75 cm apart were administered.

The average number of treatments was 1.8 per patient, with appointments scheduled several weeks apart. The results were evaluated six months after treatment, including assessment by two independent plastic surgeons based on before-and-after treatment photographs.

Marketed under the brand name Kybella, ATX-101 was approved by the FDA in 2015 for treatment of excess fat under the chin. ATX-101 is a synthetic form of the deoxycholic acid, a natural bile acid involved in fat digestion. Although multiple treatments may be needed, the results achieved by ATX-101 treatment are considered permanent.

"The majority of patients (98 percent) experienced an improvement in jowl appearance," Dr. Shridharani writes. In the article and accompanying video on the Plastic and Reconstructive Surgery®, the official medical journal of the ® website, he shares his technique for pre-injection markup and ATX-101 injection, including simple steps to protect a nerve running through the treatment area.

Just one patient-rated improvement inadequate after ATX-101 injection and was considering a surgical neck lift for further treatment. Most patients experienced some tenderness, swelling and numbness at the injection site, which resolved in a few days to weeks. Three patients had temporary nerve weakness (paresis), which resolved in about a month.

Some patients underwent ATX-101 injection for excess fat in the jowls and under the chin (double chin) at the same time. "Men may be particularly interested in jowl fat treatment compared with typical cosmetic procedures," such as liposuction, Dr. Shridharani writes. In his experience, high satisfaction rates with ATX-101 treatment bring patients back to the plastic surgery practice for further procedures.

According to Dr. Shridharani, "In this first prospective, interventional study, ATX-101 was effective in improving jowl appearance and was well tolerated in this patient population, providing a minimally invasive treatment option for jowling caused by excess fat."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

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Article: "The Nonsurgical Rhinoplasty: A Retrospective Review of 5000 Treatments" (doi: 10.1097/PRS.0000000000006554)