Skin Necrosis Following Adipolytic Treatment

Aqualyx, a non-Food and Drug Administration (FDA) approved sodium deoxycholate-based fat reduction medical device available in Europe and other regions, is generally safe with minor, transient, and side effects being common. Severe adverse events are extremely rare. This report presents a case of necrosis following Aqualyx injection in which a 30-year-old male with a body mass index (BMI) of 28.4 kg/m² underwent Aqualyx treatment for flank adiposity. The injection was performed using an intralipotherapy needle, delivering 8 ml of solution per side by continuous retrograde injection. The patient developed localized discoloration and discomfort, progressing to necrosis on the right side. Targeted antibiotics, surgical debridement and negative pressure wound therapy led to complete healing within a month. Long-term follow-up for 12 months demonstrated sustained healing, with no recurrence of necrosis and continued satisfactory cosmetic results following adjunct microneedling and mesotherapy sessions. Deoxycholate solutions may induce necrosis if injected improperly, possibly due to vascular occlusion or too superficial injection. Increased awareness and training are necessary. Aqualyx is generally safe, but rare complications like necrosis require vigilance, proper technique, and preventive measures.