O R I G I N A L A R T I C L E BASIC SCIENCE/EXPERIMENTAL
Deoxycholic Acid and the Marginal Mandibular Nerve:
A Cadaver Study
Alexander D. Blandford
Jason M. Young
Thomas P. Plesec
Catherine J. Hwang
Julian D. Perry
Received: 4 March 2018 / Accepted: 22 May 2018
Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018
Background One of the rare but serious complications
observed with deoxycholic acid administration is damage
to the marginal mandibular nerve. In this study, we eval-
uated if deoxycholic acid directly induces histologic
damage to fresh cadaveric marginal mandibular nerve.
Methods A segment of marginal mandibular nerve was
harvested from 12 hemifaces of 6 fresh cadavers. The nerve
specimen was exposed to either 0.9% sterile saline for
24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxy-
cholic acid (10 mg/ml) for 24 h. The nerve specimens were
then ﬁxed in glutaraldehyde for a minimum of 24 h.
Toluidine blue stained sections were evaluated for stain
intensity using light microscopy and color deconvolution
image analysis. Supraplatysmal fat was harvested as a
positive control and exposed to the same treatments as the
marginal mandibular nerve specimens, then evaluated
using transmission electron microscopy.
Results Toluidine blue staining was less in the marginal
mandibular nerve exposed to deoxycholic acid when
compared to saline. The specimen exposed to deoxycholic
acid for 24 h showed less toluidine blue staining than that
of the nerve exposed to deoxycholic acid for 20 min.
Transmission electron microscopy of submental fat
exposed to deoxycholic acid revealed disruption of adipo-
cyte cell membrane integrity and loss of cellular organelles
when compared to specimens only exposed to saline.
Conclusions Deoxycholic acid (10 mg/ml) damages the
marginal mandibular nerve myelin sheath in fresh human
cadaver specimens. Direct deoxycholic acid neurotoxicity
may cause marginal mandibular nerve injury clinically.
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Keywords Deoxycholic acid Á Submental fat Á Marginal
Submental fullness, a common aesthetic concern of
patients, does not always respond to exercise and weight
loss and may possess a genetic component. A 2016
American Society for Dermatologic Surgery survey found
that 73% of the 7322 respondents are somewhat-to-ex-
tremely bothered by excess fat under their chin or neck .
The perceived submental fullness can result from
supraplatysmal fat, subplatysmal fat, prominent sub-
mandibular glands, and/or prominent anterior digastric
muscles. Surgical options such as cervicoplasty with or
without liposuction may address submental fullness, but
require signiﬁcant recovery time that may not be an
appealing ﬁrst option to some patients.
A ﬁrst in class drug, deoxycholic acid (10 mg/ml), was
FDA approved in 2015 for improvement in submental fat
& Alexander D. Blandford
Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue,
Desk i-13, Cleveland, OH 44195, USA
Department of Internal Medicine, Riverside Methodist
Hospital, Columbus, OH, USA
Department of Anatomy and Neuroscience, University of
Kentucky, Lexington, KY, USA
Department of Anatomic Pathology, Cleveland Clinic,
Cleveland, OH, USA
Aesth Plast Surg