Kybella: for double chin and jowl treatment

Kybella is a prescription medication made from a synthetic form of deoxycholic acid, which is a substance found in the body that breaks down fat. It is FDA approved to treat submental fat under the chin, also called a “double chin”. When injected into the fat pad it causes destruction of fat cells. It may require several treatments but the effects are permanent.

It is also used off-label, meaning for indications not yet FDA approved, for treatment of other areas of the body such as the jowls. It can also be used on the body, typically to treat stubborn areas that do not go away with exercise, such as: around the armpits, areas on the stomach, and the thighs.

As above, treatment of the jowls is considered an off-label use of Kybella but is a common treatment. The concepts and injection technique are similar and patients tend to have good results.

Patients often have better outcomes with Kybella treatment for the jowls when used in combination with fillers and Botox. For instance, filler can be used to lift the cheek and tighten the jaw line and neuromodulators (Botox, Xeomin) can be used to lift the corners of the mouth up by inhibiting certain muscles around the mouth.

The patient above was featured in an article by the American Society of Plastic surgery and she had a Kybella treatment for jowls, filler to marionette lines, Botox to the depressor anguli oris (mouth depressor muscle) and filler to her tear troughs.

To learn more about filler read Filler 101 here. To learn more about Botox, read Botox 101 here.

Knowledge of anatomy and technique are crucial to having positive outcomes with Kybella treatment. As you can see from the photo above, there are a lot of structures, vessels and a major nerve near the treatment areas and the photo only highlights the main ones. This is why much of the session is revolved about prep, which includes:

• Your injector will first ask you to make various facial expressions and will lightly pinch and pull on your skin. This is to evaluate skin elasticity, location of fat pad and other anatomical landmarks.
• The injector will then mark off certain landmarks and create a small area that is considered safe for treatment.
• A grid is placed over the treatment area, or may be drawn on, for areas of injection. The number of injections, or actual needle pokes, varies based on the size of the area treated but 20-30 is not uncommon.
• The number of marks will be counted and an appropriate number of syringes will be drawn up. An average of 2-4 vials/ treatment is typical; which could be 4-8 syringes.
• Ice is placed on the treatment area, and at times numbing cream may be used prior to the grid placement.
• 2-4 treatments are usually needed for best results but some clients require up to 6 treatments.
• Cost varies but is usually around $1200-2400/treatment depending on dosage prescribed and if other treatments are done in conjunction.
• Cost for jowls typically starts at $600-1200/treatment depending on size of area treated. Less treatments are needed in this area for most patients (average of 1-2)

The actual procedure (after prep) only takes about 3-5 minutes, depending on the size of the area. Most people experience some pain with needle puncture and a slight burning of the medication.

More immense burning starts about 5 minutes after injection and lasts 10-15 minutes. Ice is placed immediately post-procedure for comfort during the burning phase and most patients find this uncomfortable but tolerable.

Post-procedure swelling and redness is common and swelling is actually encouraged as it means the medication is working.

Most side effects associated with Kybella are mild and brief, including: discomfort during injection, redness, swelling, bruising, and areas of hardness at the injections sites. However, moderate-severe side effects are also possible but typically resolve spontaneously. These side effects include:

• Difficulty swallowing: this can result due to swelling in the area and usually will resolve within a few days but could last longer.
• Nerve damage: the marginal mandibular nerve runs along the jaw, as seen in the photo, and can vary by several centimeters in each person. So even if all landmarks are followed it is still possible to have damage to this nerve; which causes an uneven smile or facial weakness. Luckily it will typically repair within a few months.
• Hair loss: as seen in the photo of the man below with bald patches at the injection sites. It is unclear if this might resolve or will be permanent.
• Ulcers: if injected too superficially the medication can cause damage to the skin including ulcers or necrosis (tissue death). This typically resolves with good wound care and follow up.

Who should not receive Kybella?

• If there is an active infection in the area to be treated you should not receive Kybella
• If you have a pre-existing problem with swallowing (dysphagia) you should not receive Kybella
• If you have prior nerve damage to your face, or in the area to be treated, you should not have Kybella
• If you are pregnant or breast-feeding you should not have this treatment as it has not been studies
• You should alert your healthcare provider of any medical problems, current medications and any other procedures you have had to determine if you are eligible for treatment.

Have questions? We’d love to hear from you! Click below to contact us or to book a consult for Kybella. Consult are always free!

Allergan (2018). About Kybella. Retrieved October 16, 2018 from https://www.mykybella.com/what-is-kybella

Deoxycholic Acid (2018). In Epocrates Essentials for Apple iOS (Version 11.4.1)[Mobile Application Software] Retrieved from http://www.epocrates.com/mobile/iphone/essentials

Mess, S. (2017). Lower Face Rejuvenation with Injections: Botox, Juvederm, and Kybella for Marionette Lines and Jowls. Plastic and reconstructive surgery. Global open, 5(11), e1551. doi:10.1097/GOX.0000000000001551

Souyoul, S., Gioe, O., Emerson, A., & Hooper, D. O. (2017). Alopecia after injection of ATX-101 for reduction of submental fat. JAAD case reports, 3(3), 250-252. doi:10.1016/j.jdcr.2017.02.021