A Systematic Review of Injectable Lipolytic Agents for Nonsubmental Fat Reduction

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BACKGROUND: Injectable lipolytic agents have gained popularity as a noninvasive approach to localized fat reduction. Deoxycholic acid remains the only U.S. Food and Drug Administration-approved agent for submental fat reduction, and its application for nonsubmental regions is an emerging area of interest. This systematic review evaluates the literature on the use of injectable lipolytic agents beyond the submental region. METHODS: A systematic review was conducted using PubMed, MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. Studies evaluating the use of injectable lipolytic agents for nonsubmental fat reduction were included. Extracted data included treatment outcomes, patient satisfaction, adverse events, and cost considerations. Bias was assessed using ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) and RoB 2 (Risk of Bias in Randomized Trials). RESULTS: Twenty-five studies met inclusion criteria, encompassing 3178 patients treated with various agents, including deoxycholic acid, phosphatidylcholine, and emerging formulations, such as CBL-514 and caffeine-hyaluronic acid. Significant reductions in localized adiposity were reported in 93.75% of studies, with 37.5% achieving statistical significance. Adverse events were generally mild and transient. Patient satisfaction rates varied from 57.1% to 86%. Cost comparisons indicated that injectable treatments require multiple sessions, making them costlier than single-session surgical liposuction but competitive with noninvasive modalities, such as cryolipolysis. CONCLUSIONS: Injectable lipolytic agents offer a promising, minimally invasive alternative for fat reduction in nonsubmental regions. However, further clinical trials are needed to standardize treatment protocols, evaluate long-term efficacy, and assess the cost-effectiveness of combining injectables with other weight management strategies. Expanding Food and Drug Administration approval for additional indications remains a potential future direction.

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