Deoxycholic acid injections are indicated for improvement in the appearance of moderate to severe convexity of fullness associated with submental fat, also called ‘double chin’ in adults.  The safe and effective use of Deoxycholic acid for the treatment of subcutaneous fat outside the submental region has not been established and is off label.

CONTRAINDICATION: Deoxycholic acid is contraindicated when there is an infection at the injection site. There are no studies on safely during pregnancy or breast feeding. If you are pregnant or breast feeding then you should not proceed with treatment.

Initial each statement to accept the risk: 

RISK: Every injection of any medication involves a certain amount of risk. Below are risks reported during clinical studies that specific to the injection of Deoxycholic acid.

I have requested treatment with Deoxycholic acid. The side effects and risk associate with this treatment been explained to me. I have been told about the potential benefits of treatment, and alternative treatment, including no treatment at all. I understand clinical trails show multiple treatments are necessary to produce permanent results, and that increase in body weight may diminish the effects of treatment. I have read and fully understand this consent form. I have been able to ask questions about treatment and all of my questions have been answered to my satisfaction. I hereby consent to treatment with Deoxycholic acid.
I consent to the taking photographs and authorize their anonymous use for the purposeof medial audit, education and promotion.