Kybella in NYC
Kybella is an injectable form of deoxycholic acid used to reduce fullness under the chin. It destroys fat cells in the area it is injected into, and the body clears them over the following weeks. Dr. Darren M. Smith performs the injections himself at his Manhattan office. It is a course of treatments rather than a single visit, and it is the only injectable with FDA approval for this purpose.
What Kybella is and how it works
Kybella is a prescription medicine containing synthetic deoxycholic acid. Deoxycholic acid occurs naturally in the body, where it helps break down dietary fat. Injected into the fat beneath the chin, it disrupts the membrane of the fat cells it contacts. Those cells break down and are cleared by the body over the weeks that follow.
Fat cells destroyed this way do not come back. That is not the same as a permanent result, because the fat cells that remain can still enlarge, and weight gain will change the appearance of the area.
Kybella received FDA approval in 2015 for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat in adults. That indication is specific to the area under the chin. Injection elsewhere in the face or body falls outside the approved labeling, and Dr. Smith will say plainly whether what you are asking about is an approved use or not.
Who it suits, and who it does not
Kybella suits patients whose complaint is a pocket of fat under the chin, in a neck with reasonably firm skin, at a stable weight.
It suits some patients poorly. A neck that looks full because of loose skin rather than fat will not improve from removing fat, and may look worse. A neck that looks full because of a small or set-back chin is a skeletal proportion problem, and chin augmentation addresses it. A prominent band of muscle or a low-sitting salivary gland can produce the same complaint and will not respond either.
Sorting out which of those you have is the single most useful thing that happens at consultation. Dr. Smith examines the neck and, where fat is not the main problem, says so rather than treating it as though it were.
What a treatment session is like
A session takes about twenty minutes.
- The treatment area is mapped and marked, with a grid placed over the fat that is to be treated
- The area is numbed with a topical cream, local anesthetic, or both
- A series of small injections is placed into the fat layer across the marked grid
- Ice is applied afterward
Placement matters more here than with most injectables. The medicine has to go into the fat layer and nowhere else, and the branch of the facial nerve that controls the lower lip runs close to the treatment area. That is why the mapping step is not a formality.
Patients usually feel warmth and a burning sensation for several minutes after each set of injections. That settles.
How many treatments are needed
Kybella is a course rather than a single treatment. Sessions are spaced at least a month apart, which gives the body time to clear the treated fat and lets swelling settle before the next round is planned.
How many sessions you need depends on how much fat is present and how much change you want. Dr. Smith will give you a realistic number at consultation and reassess as you go, rather than committing you to a package up front.
Kybella recovery and what to expect afterward
Swelling is the main thing to plan around, and it is more than most patients expect. The area under the chin usually swells noticeably within hours, is at its most swollen in the first few days, and settles over one to two weeks. Bruising, tenderness, numbness and firm areas under the skin are all common and all temporary.
- Leave the area alone for the first few days: no massaging, no facials, no other treatments
- Use acetaminophen rather than an NSAID for discomfort, since NSAIDs make bruising more likely
- A cold compress in the first couple of days helps with swelling
- Sleeping with the head slightly raised helps early on
- Plan the timing around anything you have in the diary, because the swelling is visible
Improvement appears gradually over the weeks after each session, and the full result of a course is judged some weeks after the last one.
Safety, side effects and risks
Common side effects are local: swelling, bruising, pain, numbness, redness and areas of firmness at the injection sites.
The risk that matters most is injury to the marginal mandibular nerve, the branch of the facial nerve that supplies the lower lip. If it is affected, the smile becomes uneven on that side. Reported cases have resolved, but this is the reason the treatment area is mapped carefully and the reason it should be injected by someone who knows the anatomy of the region.
Difficulty swallowing has been reported and resolves. Injection that is too superficial, into the skin rather than the fat, can cause ulceration and tissue damage, which is why depth and angle are not incidental details.
Kybella is not used where there is an infection at the treatment site. Tell Dr. Smith about any bleeding problem, any medicine acting as a blood thinner, any previous surgery or treatment in the neck, and if you are pregnant or breastfeeding. Any decision to hold a blood thinner is made with the physician who prescribed it.
How it compares with the alternatives
The main alternative for the same complaint is liposuction of the area under the chin, which removes the fat directly in one session rather than over a course of injections. It involves a small incision, local anesthesia and a short recovery, and it gives the surgeon direct control over how much fat comes out and where.
Where the problem is skin laxity rather than fat, neither approach is the answer. Radiofrequency skin tightening or a neck lift address that instead, and a patient with both may need a combination.
Dr. Smith does not offer CoolSculpting.
What determines the cost of Kybella
Kybella is priced by the amount of product used, so the cost of a course depends on the size of the area and the number of sessions.
- How much product each session requires, which follows from the size of the treatment area
- How many sessions your plan calls for
- Whether anything else is done at the same visit
You are given an exact figure at consultation before anything is booked. Dr. Smith is out of network with all insurance plans, and the practice helps patients use out-of-network benefits toward care; cosmetic treatment is not covered. Financing is available through CareCredit and Alphaeon Credit. The consultation fee is $500 and is applied toward any procedure.
Common questions about Kybella
How many treatments will I need?
More than one, and the number depends on how much fat is present and how much change you want. Sessions are at least a month apart. Dr. Smith gives you a realistic estimate at consultation and reviews it as you go.
Does the fat come back?
The fat cells that are destroyed do not return. The remaining fat cells can still enlarge, so weight gain will change how the area looks.
How much swelling should I expect?
More than you would expect from an injection. The area usually swells visibly within hours and settles over one to two weeks. Most patients plan the timing of each session around this.
Does it hurt?
The injections themselves are numbed. Warmth and a burning sensation for several minutes afterward are normal, and tenderness lasts a few days.
Can Kybella be used on the jowls or elsewhere on the face?
Its FDA approval covers fullness under the chin only. Use anywhere else is off-label. Dr. Smith will tell you whether what you are asking about is an approved use before you decide anything.
Kybella or liposuction under the chin?
Liposuction removes the fat in one session and gives direct control over the contour; Kybella avoids an incision but takes a course of treatments. Which is more appropriate depends on how much fat there is, your skin quality and what you are willing to trade in recovery time.
Will it tighten my skin?
Kybella treats fat. It is not a skin tightening treatment, and a neck that is full because of loose skin will not improve from it.
When will I see the result?
Change appears gradually in the weeks after each session, as the treated fat is cleared. The result of a full course is judged some weeks after the final session.
Is it covered by insurance?
No. This is cosmetic treatment, and Dr. Smith is out of network with all insurance plans.
Can I have it while pregnant or breastfeeding?
It is not given during pregnancy or breastfeeding.
Who performs the injections?
Dr. Smith performs them himself. He is board-certified by the American Board of Plastic Surgery and a Fellow of the American College of Surgeons, with fellowship training in craniofacial and aesthetic surgery.