Kybella in NYC
Kybella is a prescription injection of deoxycholic acid that destroys fat cells beneath the chin. It is approved for adults with moderate to severe fullness caused by fat under the chin. Dr. Smith generally does not favor this approach: in his clinical judgment, it is less precise and less predictable than chin liposuction, recovery can look and feel worse, and the contour improvement is substantially less. He encourages patients considering Kybella to explore chin liposuction. The best approach depends on your anatomy and goals.
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 moderate to severe fullness caused by fat under the chin in adults. That approval is specific to the submental area. Treatment elsewhere in the face or body is not approved and is not recommended in the current prescribing information.
Who it suits, and who it does not
Kybella may be considered for adults with fat beneath the chin and reasonably firm skin. Meeting those criteria does not make it Dr. Smith's preferred approach. He encourages patients to compare the precision, expected contour improvement and recovery of chin liposuction before choosing injections.
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. Your clinician 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.
The number of sessions depends on the amount of fat and the response to treatment. The prescribing information allows up to six treatments, at least one month apart. Repeated treatment and variable improvement are part of why Dr. Smith generally favors chin liposuction for suitable patients.
Kybella recovery and what to expect afterward
Swelling, bruising, pain, numbness and firmness can be conspicuous after Kybella and may last several weeks. Avoiding an incision does not necessarily mean an easier recovery. In Dr. Smith's experience, the swelling and discomfort can look and feel worse than recovery after chin liposuction, and each injection session may bring another recovery period.
- 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.
Kybella can injure the marginal mandibular nerve, a branch of the facial nerve that supplies the lower lip, causing an uneven smile or facial weakness. Cases reported in the clinical trials resolved, but this does not guarantee the course of an individual complication. Careful technique and knowledge of the anatomy are essential.
Difficulty swallowing can occur. Ulceration, tissue damage, infection, nodules and other serious injection-site reactions have also been reported. Contact your treating clinician promptly for difficulty swallowing, an uneven smile, worsening pain or other concerning symptoms.
Kybella is not used where there is an infection at the treatment site. Tell your clinician 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
Dr. Smith favors chin liposuction for appropriately selected patients because it removes fat directly and gives him more control over where and how much fat is removed. In his clinical judgment, Kybella is less reliable and delivers substantially less contour improvement. He also finds that its swelling and discomfort can make recovery look and feel worse, despite avoiding an incision. Learn about chin liposuction. Liposuction is surgery and carries its own risks; an examination is needed to decide whether it is appropriate.
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
For patients exploring chin liposuction, preliminary price estimates are available by calling 212-633-0627 before committing to a consultation. A surgical consultation with Dr. Smith is $500, collected at booking and credited toward your procedure. Your personalized treatment plan and final quote are determined after the consultation.
Common questions about Kybella
How many treatments will I need?
The number varies with the amount of fat and the response to treatment. Up to six sessions may be given, at least one month apart. Dr. Smith encourages patients to weigh this repeated-treatment course against chin liposuction.
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?
Swelling can be significant, and numbness or firmness may last longer than the visible swelling. In Dr. Smith's experience, the recovery can look and feel worse than chin liposuction recovery. The duration varies between patients and between treatment sessions.
Does it hurt?
Numbing measures can reduce discomfort during injection. Burning, pain and tenderness may follow, and their intensity and duration vary. Persistent or worsening symptoms should be discussed with the treating clinician.
Can Kybella be used on the jowls or elsewhere on the face?
Kybella is FDA approved for moderate to severe fullness caused by fat under the chin in adults. Treatment elsewhere in the face or body is not approved and is not recommended in the current prescribing information.
Kybella or liposuction under the chin?
For suitable patients, Dr. Smith generally favors chin liposuction. He considers it more precise and predictable, with substantially greater contour improvement than Kybella. He also finds that Kybella's swelling and discomfort can make recovery more burdensome. Chin liposuction is surgery and has its own risks; candidacy requires an examination.
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.
What does Dr. Smith recommend instead?
Dr. Smith encourages patients considering Kybella to explore chin liposuction. An examination can determine whether fullness comes from fat, loose skin or another anatomical feature, and whether liposuction is appropriate.