Deoxycholic acid destroys fat cells irreversibly. On how DCA differs from conventional contour injections, design around the marginal mandibular nerve, and recovery.
Hello. This is Dr. Lee Yumin of MeSOnBom Clinic.
After a holiday period, more people come to us saying their facial line has collapsed and the area under the chin has thickened.
For something described as the price of good food and rest, a double chin visible in every mirror is a considerable source of stress.
Fat under the chin arises not only from weight gain but also from loss of firmness with age and from genetic factors, and once settled it is notoriously resistant to diet and exercise alone.
In the past, surgical options such as liposuction were the main consideration, but because of the long recovery and the burden of surgery, far more people now look for non-surgical injections.
Today I want to talk in depth about the DCA injection, currently the most reliable treatment for a double chin in aesthetic medicine.
Before explaining this treatment, it is worth addressing the so-called contour injections we have long been familiar with.
Many people will have had a contour injection for a double chin.
But the ingredients are mixed differently at each clinic, and the recipe is often not clearly disclosed, which inevitably leaves patients uneasy.
In some cases steroids such as triamcinolone were mixed in indiscriminately to maximise the effect.
Steroids can be effective at temporarily reducing the size of fat cells, but with repeated treatment they carry a risk of skin depression, skin atrophy and — in women — systemic hormonal side effects such as irregular bleeding or disrupted periods.
As those cases became known, doubts about the safety of contour injections grew, and both patients and doctors wanted a treatment that was safer, with clear ingredients and a lasting effect.
The DCA injection released by Daewoong Pharmaceutical answers that need.
The main reason it draws attention is the distinctive mechanism of its active ingredient, deoxycholic acid.
Deoxycholic acid is a safe ingredient synthesised from a substance our own digestive system (the gallbladder) secretes naturally to break down fat.
Where conventional contour injections only reduced the size of fat cells temporarily, so that they returned in time, deoxycholic acid destroys the membrane of the fat cell itself.
This is called irreversible adipocytolysis.
The destroyed fat cells are cleared from the body by macrophages, and because the number of cells is reduced, a semi-permanent result can be expected without rebound, unless weight increases sharply.
Collagen synthesis is also induced where the fat has gone, so firmness of the skin under the chin improves as well.
Destroying submental fat with deoxycholic acid was not first done with this product.
Anyone with an interest in aesthetic medicine will know that Kybella, released by Allergan (now AbbVie) in the United States, came first.
Kybella received US FDA approval in 2015 for improving submental fat — a landmark product whose efficacy and safety are recognised worldwide.
It was introduced in Korea around 2018, and I attended many seminars and performed the treatment myself, confirming how well it works.
A search of the literature shows a substantial body of medical evidence for meaningful improvement in submental fat.
But Kybella had one critical drawback: cost.
At close to a million won per session, the protocol of three or more sessions was simply beyond what most patients could bear.
Despite its efficacy, it never really found its place in the market.
Later, the domestic pharmaceutical company Daewoong launched the DCA injection based on the same deoxycholic acid ingredient.
With efficacy comparable to the imported original but at a far more reasonable cost, it became a game changer for double chin treatment.
It may look like a simple injection, but this is a prescription medicine that should not be approached casually.
The part that matters most, and deserves the most care, is the design before treatment.
The marginal mandibular nerve, which governs jaw movement and the lowering of the corners of the mouth, runs beneath the chin.
If the solution is injected excessively near that nerve, temporary nerve injury can cause the corners of the mouth to become asymmetric.
It recovers fully in time, but it causes the patient great anxiety, so preventing it entirely is a core part of the doctor's skill.
Before treatment we have the patient raise their chin, palpate the border of the jawbone and the thyroid cartilage, and mark the danger zone thoroughly in pen.
Once the safe treatment area is fixed clear of the nerve, we mark points at exactly 1cm intervals (grid marking) so that the solution spreads evenly and destroys fat uniformly rather than clumping.
With one vial (2cc), we typically divide it into ten injections of 0.2cc across those 1cm points.
The injection itself takes around five minutes, but far more time and care goes into drawing the plan on the face and measuring the intervals, in order to avoid serious nerve injury and achieve the best result.
I always tell patients honestly: it is safe because there is no steroid and the result is reliable, but recovery asks for some patience.
Here are the main side effects and how to handle them, based on clinical data and our own experience.
This is the most common effect and occurs in every case.
As the deoxycholic acid destroys fat cells, a natural acute inflammatory response causes swelling.
Swelling is a positive sign that the medication is working and destroying fat.
It usually peaks two to three days after treatment, and the area can look fuller for anywhere from a week to a month.
So if you have an important interview or a wedding shoot coming up, it is best to avoid treatment within a month of it.
Wearing a compression band afterwards helps the swelling subside.
There is a characteristic burning and dull ache as the solution is injected.
Pain can continue for a day or two after treatment as the anaesthetic wears off.
(When I had it myself, the ache afterwards was greater than the needle going in.)
A cold compress helps with both pain and swelling.
As the swelling subsides, the area under the chin can feel firm and hardened, like a coin.
This too is an entirely normal part of healing, as destroyed fat cells are cleared and new collagen forms and the tissue remodels.
It softens naturally over time, so there is no need for concern.
As noted under design, rarely the solution can affect the marginal mandibular nerve and produce an asymmetric smile.
This is not permanent damage and returns fully to normal within weeks to months.
It can be prevented through accurate anatomical understanding and careful design by an experienced doctor.
This is a prescription medicine approved by the Ministry of Food and Drug Safety specifically for improving moderate to severe convex or excessive submental fat.
It is therefore not recommended, and in principle should not be used, on other areas such as the cheeks, deep cheek fat or the body.
Because the aim is to destroy fat, it is also unsuitable for slimmer patients who have little submental fat but appear to have a double chin because the skin has lost firmness and sagged.
It is best suited to those with a thick layer of fat that can be pinched.
The most noticeable results usually come from about three treatments at monthly intervals.
If you want a strong lifting effect alongside fat reduction, I recommend combining it with a device treatment such as Shurink (HIFU) or InMode (RF).
Emptying out unwanted fat with the DCA injection and then drawing the loosened skin tight with a lifting device maximises the synergy.
If a double chin has been a source of stress for a long time, or if you have grown tired of the uncertainty of conventional contour injections, the DCA injection may be a good answer.
You can feel a change in fat even after a single session, so rather than moving from one treatment to another, it is worth experiencing a proper fat-destroying treatment.
I hope this has helped on the way back to confidence in front of the mirror. Thank you.
Our medical team will advise you based on your skin condition.
