Does Belkyra Plus reduce double chin? What research on fat-dissolving injections reveals about frequency and precautions

For double chin fat, deoxycholic acid injection (ATX-101) showed that approximately 60% of patients achieved at least one grade improvement in physician assessment, exceeding the 28.6% seen with placebo injection in clinical trials[1]. However, most research is specific to this formulation, and results may not directly apply to injections with different ingredients or concentrations[1][2]. It is important to consider frequency and precautions regarding nerve involvement.

How does Belkyra Plus reduce fat?

Belkyra Plus is a fat-dissolving injection with deoxycholic acid as its primary ingredient. Deoxycholic acid destroys the cell membranes of fat cells at the injection site; the resulting inflammation then clears away the debris and lipids from the damaged cells[3].

After this inflammation, collagen is said to be produced, leading to tightening of skin and tissue[4].

How well established is the efficacy?

Efficacy for double chin has been confirmed in randomized controlled trials comparing against placebo injection[1][5]. In a combined analysis of two European trials, 58.8–63.8% of patients achieved at least one grade improvement in physician assessment, compared with 28.6% for placebo[1].

While efficacy was confirmed in a meta-analysis of randomized trials, all studies carry a potential risk of bias from pharmaceutical company involvement[2]. It is safest to interpret the figures with these limitations in mind.

How many sessions and how long does the effect last?

In trials, injections were administered approximately every 28 days[1], with a maximum of 6 sessions available; however, most patients achieved at least one grade improvement within 2–4 sessions[6]. Some patients were satisfied and completed treatment before reaching 6 sessions[6].

Efficacy was confirmed on follow-up for up to 3 years, during which no new safety concerns emerged[7]On the other hand, the North American trial had follow-up only through 44 weeks, which the authors also noted as a limitation.[5].

Swelling, numbness, and nerve damage—what are the risks?

The most common side effects are swelling, pain, redness, bruising, and numbness at the injection site, and most resolved within one month.[7]With repeated treatments, the frequency and severity of side effects decreased.[6][7].

In the North American trial, 14.3% (17 out of 119 people) discontinued treatment due to side effects.[5]It is important to be able to consult promptly if concerning symptoms persist.

Though rare, injury to the nerve controlling mouth movement can cause asymmetry of the mouth when smiling.[4]If the injection is placed too deeply and reaches the neck muscles, the smile can also become distorted; therefore, injection at the midpoint depth of the subcutaneous fat is recommended.[4]In animal studies with mice, nerve damage occurred when the injection was placed near nerves.[8].

What should you check before treatment?

The literature states that it is important to carefully select candidates, and to follow guidelines regarding dose, frequency, and injection technique.[9]During consultation, consider asking the following points.

Cause: Is the submental fullness truly due to fat?[9]

No-injection zone: Which areas should be avoided to protect nerves?[10]

Interval: Will the treatment be evaluated with at least 30 days between injections?[4]

Jaw angle (jawline): FDA and Health Canada approval is for submental fat only; off-label use for the jawline applies.[9][3]

In a report of 167 patients treated with a defined no-injection zone to avoid nerves and broad treatment of the submental area, fullness improved in 160 patients (95.8%), and most side effects were temporary swelling, numbness, and pain.[10].

Whether submental fullness is due to fat and how many treatments are needed cannot be determined from the article alone. During consultation, ask your doctor to examine the thickness of the submental fat and skin laxity, and to confirm the injection zone, nerve-avoidance locations, and expected number of treatments.