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Is Kybella a Good Procedure for Double Chin Treatment?

There was initially a lot of excitement about the product Kybella around the time it entered the market in 2015. Allergan, the company behind Kybella, obtained FDA approval for deoxycholic acid as an injectable, non-surgical double chin treatment. There is often a lot of buzz for any new non-surgical treatment as an alternative to surgery. So, is Kybella a more effective, and convenient treatment to address double chins in comparison to a surgical procedure? I’ll discuss how I looked at Kybella as an option in my practice.

I have been treating the double chin, or submental fat area throughout my career using different methods of liposuction or facial liposculpture, as well as non-surgical long pulsed 1064 YAG laser.

Facial liposculpture - Double chin treatment by Dr. Amiya Prasad New York
Facial liposculpture - Double chin treatment at Prasad Cosmetic Surgery New York

Although I’m trained and practice as a surgeon, I routinely integrate non-surgical procedures to help my patients in the best way I can. I have always pursued my training and ongoing education by integrating information and experience from multiple specialties to do what matters most – helping my patients in the safest, most predictable, and most beneficial way.

Being in practice for so long, I’ve witnessed such hypocritical self-interest and inter-specialty rivalry that has resulted in an erosion of the general public’s trust in the medical profession. Every physician’s single mission should simply be to put the patient’s best interests above everything, so let’s take a look at Kybella.

Kybella double chin treatment before and after 4 sessions
Kybella injection before and after 4 sessions

What is Kybella and How Does it Work?

The active ingredient in Kybella is a chemical called deoxycholic acid. Deoxycholic acid naturally exists in your bile, which is stored in your gallbladder, and is used for the digestion of fat. It makes sense that the same chemical for fat digestion in your intestines can be used for fat dissolving under the skin. People who want to improve the appearance of a double chin are understandably excited about being able to have their double chin improve without surgery. The catch is that Kybella can take up to 6 treatment sessions to achieve the desired results, which means you have to have multiple injections over multiple sessions, which can be as many as 50 injections in the treatment area..

who could benefit from kybella injection illustration
only one can benefit from kybella injection illustration

Possible Kybella Side Effects

Kybella injections typically cause swelling as well as skin discoloration for extended periods. The ability to control the amount of fat being dissolved is difficult with Kybella since a liquid injected under your skin can spread to areas where you don’t want it to go. This is a problem because a certain layer of fat directly below your skin is beneficial for health, as well as youthful-looking skin. As mentioned earlier, my objective is to help my patients by recommending procedures which are safe, highly predictable, and allow quick recovery.

Many people are afraid of the word “surgery”, so many non-surgeons, as well as non-physicians, unethically take advantage of this fear for their financial benefit. I’ve helped many patients who were apprehensive about surgery come to understand some basic principles:

  1. Entering the skin with a needle is an invasive procedure, subject to many of the same complications as surgery
  2. A surgical procedure performed without general anesthesia can be safer and more predictable than a non-surgical alternative.

Double Chin Liposuction

In my practice, I routinely reduce fat under the chin and jowls using facial liposculpture, done with local anesthesia and LITE®  IV sedation. I’m able to sculpt the fat precisely, which means being able to protect the skin, and allow the retention of the healthy layer of fat needed for smoother-looking skin. This procedure takes about an hour to perform, and the benefits are appreciated in real-time.  The patient can go back to work within a few days, and they don’t typically need any additional treatment sessions.

double chin lipo before and after
double chin liposuction before and after

The highly aggressive marketing of Kybella by both the company, and the practitioners hoping to profit from another cosmetic retail service, have resulted in everyone concerned about the appearance of their neck thinking that Kybella is the way to go.

There are some limits to both facial liposculpture, and Kybella. If you are significantly overweight, it’s important to understand through a proper evaluation how much of the appearance of the under chin, and neck area are related to the fat that is accessible; and how much fat is in the deeper tissue which is not accessible. Optimally, a treatment like facial liposculpture is done for stubborn fat volume not diminishing despite diet and exercise, and being within ten pounds of your ideal body weight.

Facelift and neck lift before and after
Facelift and neck lift before and after by Dr. Amiya Prasad, Manhattan New York

Loose skin under the neck is not due to fat, but to skin and soft tissue sagging associated with age, or from significant weight loss. Generally, this needs to be addressed by some type of lifting procedure, including the excision of redundant skin. For example, if the loose skin is due to aging, then a neck lifting procedure may be appropriate.

Non-surgical laser jowl lift before and after
Non-surgical laser jowl lift before and after by Dr. Amiya Prasad Garden City, Long Island

For people with moderate skin laxity, a minimally invasive suture suspension neck lift may be performed without the need for more extensive surgery. If there is a small amount of fat and skin laxity, a non-surgical jowl lift lifting procedure such as a long pulse Nd YAG laser treatment, can both reduce fat, and contract the skin to create better jawline definition.

Suture suspension neck lift before and after 1 week recovery
Suture suspension neck lift before and after 1 week recovery procedure done by Dr. Amiya Prasad Garden City, Long Island

Another issue, which is not addressed by facial liposculpture, and Kybella is the appearance of platysmal bands. The platysma muscle starts at the base of the neck, and runs up the sides of the neck to the chin. Platysmal bands can be addressed with a neurotoxin, such as botulinum toxins Botox, Dysport, Xeomin, and Juneau, or more prominent cases would need a surgical procedure called a platysmaplasty. If there is also significant skin laxity then a neck lift is also an option.

Before and after Platysmaplasty
Before and after Platysmaplasty
The appearance of excess volume under the chin can also be caused by the natural anatomy of having a low hyoid bone. The hyoid bone is responsible for the angle between the chin and neck. A low hyoid bone can create the perception of having a double chin.
large volume fat under chin example
Loose skin under the chin can also be associated with a deficiency in the bone structure, which can be caused by genetics, aging, or a combination of the two. I perform a procedure called Structural Volumizing where I place long-lasting hyaluronic acid fillers such as Juvederm Ultra Plus, and Juvederm Voluma in a way, which is comparable to the placement of facial implants. By enhancing the bone structure of the cheeks, chin, and jaw angle, the neck skin can be elevated and the facial proportions can look significantly better.
juvederm chin filler before and after female
before and after chin filler female

While having a non-surgical treatment to improve the appearance of a “double chin” may be attractive, it’s important to recognize that there are many different anatomic issues, which can all be described as a “double chin”. This means that a proper examination by a doctor without any bias is the first step to your understanding of what treatment strategy is best for you.

Facial liposculpture - Double chin lipo treatment before and after at Prasad Cosmetic Surgery New York
Facial liposculpture - Double chin liposuction before and after

Double Chin Treatment in Manhattan New York and Garden City Long Island

If you have fat under the chin and you are in a healthy weight range with good skin tone, the question is, which is a better option, Kybella or facial liposculpture? In my opinion, I am serving my patients better by performing facial liposculpture with local anesthesia in one treatment session, rather than having them come in for multiple sessions with less predictability, and more total recovery time using Kybella.

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