One of the most important aspects of facial rejuvenation is providing a harmonious balance to the shape and structure of the face. Injectable treatments such as Botox and fillers (including Voluma, Vollure, Volbella, and Juvederm) focus on improvement of the upper face and the mid-face. However, many people are also concerned about the appearance of the lower face. Now with Kybella, we have a treatment for jawline rejuvenation.
What happens to the jawline over time?
As we mature there are a number of changes that occur in the face. The structure and shape of bones change and move around. Fat is gained or lost and can be deposited in certain areas. And the amount of collagen in the skin decreases over time, leading to sagging and wrinkles. Together this leads to a blunting of the jawline. We lose the sharp and defined jawline that is associated with youth and beauty. The causes of these changes include age, sun damage, weight gain, and genetics. While we can control our weight and our sun exposure, unfortunately we cannot control the other two factors. Now with Kybella, we have a treatment that can rejuvenate the jawline to provide a more beautiful appearance.
What is Kybella?
Kybella is the first and thus far only FDA-approved, non-surgical, injectable treatment for what is called submental fullness, or more commonly referred to as the double chin. The active ingredient in Kybella (deoxycholic acid) is a naturally occurring salt produced in the body that is used to digest the dietary fat. When injected into the skin, Kybella will dissolve the fat and it is naturally eliminated over time. What patients love most about Kybella is that the results are permanent. Unlike Botox and fillers such as Voluma, Vollure, Volbella, and Juvederm where periodic maintenance treatments are required, with Kybella once the series of treatments is complete, your body is no longer able to store nor accumulate fat in the area. Therefore, maintenance treatments are not required with Kybella.
What happens during a Kybella treatment?
The Kybella treatment is very easy. We start by taking baseline photographs in multiple positions to monitor our patients’ progress. Then we apply numbing cream on the area and let it sit for about 15 minutes, after which point it is cleaned off the skin. Markings are made on the skin with a pencil and a special grid to indicate where the product is to be placed. Depending on the person and how much Kybella is used, anywhere from 20 to 60 pinches are performed. The Kybella treatment itself only takes a couple of minutes and we use a painless technique using cold air and a vibrating distractor called the beauty bar to maximize our patients’ comfort. A demonstration of the Kybella treatment is shown in the video below. Immediately after the Kybella treatment a burning sensation can be felt for about 15 minutes and we provide ice packs to control this sensation. Swelling is seen for one to two weeks after the Kybella treatment; this means that the treatment is working. This swelling from Kybella may make swallowing difficult during this time and those with difficulty swallowing at baseline area cautioned before undergoing a Kybella treatment. Sometimes lumps and bumps are formed, which resolve slowly over time. Kybella should not be used in an area of infection. Kybella has not been tested on women who are pregnant, trying to become pregnant, or breast feeding; therefore Kybella treatment is delayed until breast feeding is discontinued in these women. A series of two to six Kybella treatments is recommended and treatments are performed every three months for ideal results.
What is new with Kybella?
When the pivotal studies were performed using Kybella to get clearance from the FDA, with each treatment two vials were used in a small area and treatments were performed every four weeks for up to six treatments. This type of consistency is required to get any drug approved by the FDA. However, now that doctors are using Kybella more frequently we are incorporating some changes. For example, for those with a higher level of submental fullness three or even four vials of Kybella are being used in each session. We have found techniques to reduce the swelling after a Kybella treatment. This includes avoiding salty foods, strenuous exercise, and alcohol consumption for the first few days after a Kybella treatment. We also apply slings to wrap around the neck and top of the head in which ice packs can be placed. When laser skin tightening treatments are performed before or after the treatment, the overlying skin becomes tight and reduces the swelling after a Kybella treatment. We have also found that lumps and bumps may last more than four weeks. When the lumps and bumps are still there during a second or third Kybella treatment, the product is not able to spread to the entire area and the treatment is less effective. Increasing the interval between the Kybella treatments allows for these lumps and bumps to resolve more completely providing for a better treatment. Finally, the Kybella treatment area was initially limited to a small square under the chin in the central portion of the neck. But now we are expanding the area and placing Kybella further down and on the sides of the neck, which provides better results.
We are also using Kybella on other areas. One of the most common areas Kybella is now being used is called the bra fat. This is the area just under the underarms on the upper outer portion of the breast. Women commonly have excess fat in this area which can stick out of a bra and produce an undesired appearance. This can also occur on the back under the underarms. Kybella can also be used in the belly for excess fat in the area as well as for fat above the knees. It is important to understand that in larger areas more product will be required.