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The use of sodium deoxycholate (DC) in aesthetic medicine for reducing unwanted localized fat deposits is a procedure in use for over 30 years. Lower eyelid fat pads are one of the main imperfections of the middle third of the face. The purpose of the study is to assess the effectiveness and the safety of a second-generation injectable solution containing sodium deoxycholate 1.25% (DB125) for the treatment of lower eyelid fat pads. A multi-centre observational prospective study was carried out between May and October 2017. Patients presented various forms and degrees of lower eyelid fat pads. They were treated montly apart until the clinical result was obtained. The technique was explained. The study treated 120 patients for a total of 306 infiltration sessions (average 2.55 per patient). Patients gave the effectiveness of the treatment an average score of 7.125 (7.28 in men and 7.03 in women). The greatest successes were in patients under the age of 40. The medical evaluation showed therapeutic success in 85.83%. Adverse events were reported. The results of the study are encouraging since they have shown a therapeutic success from both the viewpoint of specialist medical assessment and from the personal, subjective view of the patients treated. This success did not show any significant differences between sex. On the other hand, outcome has been better in the younger age groups. The high degree of effectiveness shown in the study was associated with a minimal occurrence of adverse events. Therefore DB125, used with the right technique and dosage, is effective and safe to treat lower eyelid fat pads.
Deoxycholic acid; blepharoplasty; eyelid; fat pad; intralipotherapy.
Non-surgical treatment of lower eyelid fat pads with an injectable solution acid deoxycholic based
DENTAL SUPPLEMENT; R Amore 1 2 3, A Sbarbati 1, D Amuso 1 2, V Leonardi 3, S Alsanafi 4, A Greco Lucchina 5, A Scarano 2 6
Clostridium difficile is a major cause of nosocomial infections. Bacterial persistence in the gut is responsible for infection relapse; sporulation and other unidentified mechanisms contribute to this process. Intestinal bile salts cholate and deoxycholate stimulate spore germination, while deoxycholate kills vegetative cells. Here, we report that sub-lethal concentrations of deoxycholate stimulate biofilm formation, which protects C. difficile from antimicrobial compounds. The biofilm matrix is composed of extracellular DNA and proteinaceous factors that promote biofilm stability. Transcriptomic analysis indicates that deoxycholate induces metabolic pathways and cell envelope reorganization, and represses toxin and spore production. In support of the transcriptomic analysis, we show that global metabolic regulators and an uncharacterized lipoprotein contribute to deoxycholate-induced biofilm formation. Finally, Clostridium scindens enhances biofilm formation of C. difficile by converting cholate into deoxycholate. Together, our results suggest that deoxycholate is an intestinal signal that induces C. difficile persistence and may increase the risk of relapse.
A microbiota-generated bile salt induces biofilm formation in Clostridium difficile
Thomas Dubois 1 2, Yannick D N Tremblay 1, Audrey Hamiot 1 2, Isabelle Martin-Verstraete 1, Julien Deschamps 3, Marc Monot 1, Romain Briandet 3, Bruno Dupuy 4
2019 May 9
Background: Jowl fat overhang can reduce jawline definition. The most common treatment to reduce jowl fat is liposuction. ATX-101 (deoxycholic acid injection), a minimally invasive treatment approved for submental fat reduction, may also be an effective treatment for jowl fat. The current study evaluated the efficacy and safety of ATX-101 treatment for reducing jowl fat.
Methods: In this prospective single-site study, 66 adults were treated for excess jowl fat with ATX-101 (area-adjusted dose: 2 mg/cm). 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. Improvement in jowl appearance was assessed 6 months or more after the last treatment in person by the clinician. Improvement was also assessed by the patient and two independent plastic surgeons using blinded before/after treatment photographs. Safety was evaluated via adverse events.
Results: The mean number of ATX-101 treatments received was 1.8, with a mean injection volume of 0.8 ml per treatment per jowl. The majority of patients (98 percent) experienced an improvement in jowl appearance. Common adverse events were injection-site edema, numbness, tenderness, and bruising. Injection-site marginal mandibular nerve paresis and alopecia were experienced by three patients each; all events resolved without sequelae.
Conclusions: ATX-101 effectively reduced jowl fat and was well tolerated in this small cohort. Care should be taken when injecting ATX-101 into jowl fat to avoid underlying anatomic structures such as the marginal mandibular nerve.
Clinical question/level of evidence: Therapeutic, IV.
Improvement in Jowl Fat following ATX-101 Treatment: Results from a Single-Site Study
Sachin M Shridharani 1