Hi, this is Dr. Jonathan Hall coming to you from the north shore of Boston. Today I’d like to talk to you about Kybella. Kybella is a new, first in its class injectable to treat excess submental fat.
Why is Kybella exciting?
This is the first injectable approved by the FDA to treat the submental fat pad. You might know the ‘submental fat pad’ as a double chin. Taken a “selfie” lately and found yourself tipping your chin up to look a little better? You are not alone: Surveys show that 67% of patients are bothered by excess fat under their chin. This excess fat under the chin and can have many causes; including genetics, weight gain, and aging.
We have been able to treat this area with liposuction, but not every patient in my practice wants surgery. We are finding that many patients, especially many younger patients and men, would not want surgery but find the idea of an injectable to gradually remove the fat very appealing.
Kybella is a “cytolytic” agent that selectively breaks down fat. Like other popular treatments such as Botox and Hyaluronic acid fillers, it is an injectable. An important difference is that it is permanent.
When I first heard about Kybella (or ATX 101 as it was called at the time), I was concerned about having loose skin after the fat went away, like we might see with liposuction.
Phase III clinical trials demonstrated no worsening of skin laxity, which is traditionally a worry when fat is removed from an area. In actual fact, skin laxity remained the same or was improved in the clinical trials. It has been suggested the absence of exacerbation of skin laxity could be attributed to the phenomenon of neocollagenesis, which was observed in histologic samples after treatment with deoxycholate, Happily for patients, the data indicate procedures for skin tightening to address skin laxity are not necessary after submental fat decrease with deoxycholate therapy.
Who is a Candidate
Really anyone with excess submental fat. Kybella is especially great for younger patients with good skin elasticity, but even patients with decreased skin elasticity benefit. Now, if you have platysma bands that are covered by the fat, they may become more visible after Kybella treatment. But most patients would rather have the bands a little more visible than the excess submental fat. This is a great treatment for men as well. Men are often bothered by submental fat, but many would not consider surgery.
What to expect
The actual treatment takes 10-15 minutes. The fat pad under the chin is marked. The skin is cleansed, removing makeup and oils from the skin. A temporary tattoo with dots spaced 1 cm apart is applied to the skin with sterile saline. The number and location of dots within the “target” area help to guide how much Kybella is needed and aid in placing it evenly. The grid has 50 dots, and the maximum recommended dose is 5 vials or 50 dots.
A typical treatment might be 20 dots but the treatment is tailored to each patient and some patients with a larger fat pad may benefit from treatment of more dots within the target area and therefore more vials. It is important to use enough. Most of my patients will start with 2 or 3 vials.
An ice pack is placed to numb the area, and then the Kybella is injected with a very small (32 gauge) needle. You will feel a little burning just after the injections, and an ice pack is placed on top of an alcohol soaked pad at the end of your treatment and left in place for 5 minutes. The alcohol removes the dots from the temporary grid, and the ice helps until the burning goes away.
The fat pad more laterally tends to be thinner and may not need as much Kybella over the total number of treatments so the amount of dots treated may vary each time. As an example, I typically start most patients with 2-3 vials with the first treatment. They become familiar with the temporary burning sensation and the expected swelling after. I like to see patients back at the 2-month mark.
After the treatment
We recommend that you clear your social calendar for 3 days after the treatment. Our receptionist said that immediately after her treatment she felt like a pelican! Ice packs for 24-48 hours will help with the swelling. I recommend that patients avoid salty foods and alcohol, as well as exercise for 48 hours. Keeping the head elevated by sleeping on 1-2 pillows may also help. Taking an over the counter antihistamine such as Zyrtec the day before, the day of and the day after may also help, as well as NSAIDS such as Advil/Motrin/ibuprofen. Some patients take Benadryl (another antihistamine) instead of Zyrtec.
This swelling happens as the Kybella breaks down the fat cells- the inflammation causes the swelling and may also help with the tightening that is seen starting around 4 weeks after the treatment and often continuing for several months. Some doctors think that limiting the swelling with antihistamines and NSAIDS after the treatment may lead to less overall inflammation and therefore less tightening. My feeling is that the inflammation continues for a month or longer, and I would doubt that attempts to decrease the most dramatic early swelling in the first few days would significantly diminish the tightening that takes place over several months. So I recommend Ice/NSAIDS/Antihistamine to decrease swelling and discomfort. (And make sure that you avoid aspirin, NSAIDS like Motrin and fish oil/omega oils in the 10-14 days before your treatment to decrease the risk of bruising.)
The worst of the swelling is over by the 3rd day. It may take up to 4 weeks to see much but then most patients start seeing a change by week 4 and then continued tightening for 3 or even 4 months after the treatment.
When to return for another treatment
I like to see my patients back at 2 months after their treatment.
I counsel my patients that most will benefit from 2-4 treatments and some may want as many as 6. I was a little concerned when I first hear that patients were typically doing 2-4 treatments- the news is that most patients are seeing a nice improvement with each treatment and choose to repeat the treatment until they are satisfied. Most patients see a pleasing improvement by the 8th week after their first treatment and return at that time for another.
Kybella is an exciting new, first in its class injectable treatment that permanently decreases submental fat and has very little down time. Many predict that it will be the next “botox” in terms of popularity. It is still early in the Kybella story- It has only been out a short period of time. I have been performing Kybella treatments in the office since January 2016, and our early experience has been very positive and my patients seem to really like it.
What I have learned through my experience and that of other experienced Kybella physicians is to make sure that enough is used to see an effect. And we can tailor later treatments to go out more laterally and get even better shaping of the neckline.
This is Dr. Jonathan Hall and I want to thank you for reading as we talk about our early experience with Kybella I hope you have found it helpful! If you have any questions, please schedule a consultation with me and we can see if Kybella may be right for you!
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