Deoxycholic Acid for Double Chin: Non-Surgical Treatment

Double Chin That Won't Go Away With Diet

Submental fat — what we colloquially call a “double chin” — has a frustrating characteristic: it is very sensitive to genetics and very little sensitive to diet. There are thin people with double chins and overweight people without them. It is one of the most frequent reasons for facial body consultations at Santé, and for years, the only options were liposuction or radiofrequency.

Today there is an intermediate, non-surgical treatment that permanently destroys fat cells in the double chin: the so-called “enzymes for double chin,” which are actually injections of deoxycholic acid. In this article, we explain what they are, how they work, and what to expect from them.

What are “enzymes for double chin”

The term “enzymes” is what the public has popularized, but technically it is not entirely accurate. The active ingredient of the treatment is deoxycholic acid, a bile salt that the body itself produces and that has a natural function: to help break down fats in the digestive process.

When injected in a controlled concentration into the subcutaneous tissue of the double chin, this same lipolytic capacity acts locally: it breaks the membrane of fat cells, which are destroyed and processed by the body and eliminated through the lymphatic and hepatic pathways.

It is the first (and so far the only) injection with specific authorization to treat submental fat in many countries. It is marketed under different trade names depending on the market (Belkyra, Kybella).

Why it works

The mechanism, step by step:

1. Precise injection in a grid pattern, into the subcutaneous plane just under the chin.
2. Selective adipocyte lysis: deoxycholic acid preferentially destabilizes the membrane of fat cells, not that of other cells in the area (with proper technique).
3. Controlled local inflammation: the body removes cellular debris.
4. Fine fibrosis: after the inflammatory response, there is a slight retraction of the tissue. This, in an area prone to sagging like the double chin, is a favorable side effect.
5. Permanent result: eliminated fat cells do not regenerate. The number of fat cells in the area decreases permanently.

Who is it ideal for

The perfect candidate is someone with:

• Moderate double chin with a predominantly fatty component.
• Good skin tone (the skin will retract better).
• Typical age between 30 and 55 years, although there are good indications above.
• Stable weight with no expectation of major changes.
• Availability to schedule without important events in the subsequent 3 weeks.

Not an ideal candidate:

• Double chin with sagging as the main problem and little fat: here the treatment can worsen the appearance. The appropriate indication would be HIFU, radiofrequency, or surgery.
• Pregnancy or lactation.
• Active local infection.
• Significant clotting disorders.
• Previous cervical surgery with complex scarring.

How it's done at Santé

1. Clinical assessment with the facial doctor. Palpation, assessment of fat vs. sagging vs. muscle mass, clinical photography.
2. Clinical photos from various angles.
3. Marking in a grid pattern of the area to be treated (strictly submental area, with a safety margin regarding the mandibular bone and the marginal mandibular nerve).
4. Anesthesia: topical + cold cream.
5. Injection with a very fine needle into each quadrant, in the subcutaneous plane. Calibrated amounts according to the thickness of the fat deposit.
6. Ice and gentle compression at the end.

Duration: 15–25 minutes.

Number of sessions and results

• Typically 2 to 4 sessions spaced 6–8 weeks apart.
• Visible results starting from the 2nd session.
• Stabilized improvement at 2–3 months from the last session.
• Permanent results: eliminated fat cells do not return, although remaining ones can hypertrophy with significant weight gain.

Post-treatment: anticipate it

The post-treatment period is very noticeable, and it's important to know this before scheduling:

• Significant swelling for the first 3–5 days. This is the inflammatory effect that produces the result, not a complication.
• Sensitivity and mild local pain, which improves with paracetamol or ibuprofen.
• Possible bruising and transient nodules under the chin (palpable rather than visible).
• Temporary numbness of the area for 1–3 weeks.

That's why we always plan with a margin. Never less than 3 weeks before an important social event, wedding, photos, trip, etc.

Risks to be aware of

• Swelling, bruising, sensitivity: expected.
• Mild transient dysphagia in the first few days.
• Injury to the marginal mandibular nerve: infrequent with correct technique and anatomical knowledge, but worth mentioning. Usually resolves in weeks. For this reason, the treatment should always be performed by an aesthetic doctor with anatomical experience in the area.
• Allergic reactions: very rare.
• Asymmetries: correctable in successive sessions.

Enzymes vs HIFU vs cryolipolysis vs surgery

Option	When it is suitable
Deoxycholic acid (enzymes)	Double chin with moderate fat and good skin tone. You want to avoid surgery.
Submental HIFU	Component of sagging with little fat. You are looking to tighten.
Cryolipolysis with specific applicator	Moderate-to-significant fat, you prefer equipment without injections.
Surgery (cervical lipo or cervicoplasty)	Significant fat + severe sagging, or you want a definitive change in one intervention.

These options are often not mutually exclusive. A reasonable protocol can be enzymes + HIFU: enzymes reduce volume, HIFU tightens the resulting skin.

Frequently asked questions

Are “enzymes for double chin,” “Belkyra,” and “Kybella” the same thing? Yes, these are names for the same active ingredient (deoxycholic acid) in different markets or with different brand names.

Is it painful? It is tolerable with topical anesthesia. The most uncomfortable part is the first 24–48 hours after the session, due to swelling.

Can it be combined with cervical platform Botox or with HIFU? Yes, these are common combinations. The doctor decides the planning.

Do I have to be very careful with my diet afterward? Maintaining a stable weight is important. No special diet is required, but significant weight gain can worsen the result.

What if I have more sagging than fat? This is probably not the right treatment. We will guide you towards HIFU or another more suitable option during the consultation.

Book your facial assessment at Santé

A double chin seems like a simple problem, but it is not: it is important to distinguish between fat, sagging, hyoid bone position, muscle mass, and skin tone. That's why we start with a clinical assessment.

Request an appointment via WhatsApp at +34 699 14 58 87. Avenida Diagonal 384, Barcelona.