July 22, 2015

Dr. Palm Uses Kybella to Dissolve Chin Fat Without Surgery in San Diego California

As Director of Art of Skin MD, I am thrilled to share information on one of our newest procedures, Kybella by Kythera (a subsidiary of Allergan). Kybella was known as ATX-101 during clinical trials and has recently been FDA-approved for the treatment of unwanted fat in the chin area referred to as submental fullness.

I (Dr. Palm) serve as a physician trainer, speaker, and clinical investigator for Kybella.  This means I was selected among a few doctors across the U.S. to teach OTHER physicians on how to inject and use the product.  Our clinic in Solana Beach, CA has also been selected as one of the sites for a phase IV clinical trial on Kybella called the CONTOUR study.

Kybella represents a brand new procedure in the aesthetic field.  During the clinical studies, Kybella was injected monthly for up to four sessions in the area directly underneath the chin to target stubborn fat that contributes to a double chin.  Over 1000 patients were enrolled in the clinical study that led to FDA-approval with very impressive results from stringent testing guidelines.  The profile of the neck in many patients was improved dramatically.  Skin does not become lax after treatment, but adopts the new contour of the neck.

The active ingredient in Kybella is deoxycholate, also known as deoxycholic acid.  Deoxycholate is a naturally occurring substance in the body.  It is a bile acid that is normally produced by a combination of proteins produced by the liver that are in turn changed into deoxycholic acid by bacteria found in our intestines.  Therefore, the chance of sensitivity to deoxycholic acid is extremely low and Kybella is biocompatible as it is a purified form of a protein naturally produced in the body.

How does Kybella work you ask?  Well, Kybella actually causes disruption of fat cell membranes, causing the fat cell, called a adipocyte to rupture and breakdown.  The contents of the fat cell are naturally scavenged by our body and eliminated.  Therefore, the fat cells that are destroyed by Kybella are permanently eliminated.  With large weight changes, it is possible that remaining fat cells could grow, but the fat cells successfully treated with Kybella are permanently eliminated.

How will Kybella be used in actual clinical practice compared to the clinical study used for cosmetic approval you ask?  Well, we are already starting to finesse our technique and treatment regimen based on what we are seeing with Kybella in the “real world.”  For most patients at my clinic, I will treat the chin fat with Kybella approximately every 6-8 weeks instead of monthly.  Likely, patients will need only 1-3 treatments rather than up to 4 used in the clinical trials.  By spreading out the treatment sessions, the full effect of each Kybella injection session can be maximized prior to further treatment.

What is treatment like?  It is quite straightforward and easy.  Patients should anticipate approximately 30 minutes for a visit to obtain clinical photographs for their chart, marking of the area of treatment, administration of regional numbing, and administration of Kybella.  I put an emphasis on patient comfort and have found that administering small numbing dots of local anesthesia called lidocaine ensures that patients experience very little to no pain during the treatment session.  To see patient preparation in place, see the Kybella patient preparation and marking video from our YouTube channel below:

After the patient is prepared, administration of Kybella takes only about 5-10 minutes.  0.2 cc of Kybella is administered adjacent to dots from a marking grid at 1 cm increments. See my YouTube video below for the actual injection procedure of Kybella on one of our patients:

How much Kybella does someone need during treatment?  It is really determined by the amount of fat that should be treated in the chin area.  Very small areas of chin fat may require only one vial (2cc of product), while large chins may require up to five vials (10cc of product).

What is the cost of Kybella?  Kybella is priced per the vial at Art of Skin MD, so patients are only charged for the amount of product used on them, similar to Botox or Sculptra pricing.  Ranges of costs for the average patient per session is from approximately $750 to $2500, although this is subject to change and individual patient needs.

Recovery following Kybella depends on the patient.  Most patients will have some burning or stinging in the hours following Kybella in the area of treatment.  For approximately 1 day, the area of treatment can appear red, what we call in the medical field “erythema”.  For several days up to 1 week depending on the severity of the double chin, mild to moderate swelling may be experienced.  The area of treatment may feel firm for several days to weeks, a process called induration.  The area may be tender to touch for several days to weeks but is not typically severe enough to require prescription strength medication.  Very rarely, localized inflammation in the treatment area can temporarily irritate nerves in the area, causing a TEMPORARY, NOT permanent asymmetric smile or change in speech.  This is very rare and in the clinical studies, all cases resolved completely.

It is likely that Kybella will be used with other treatment modalities for complete neck rejuvenation.  Botox or Dysport can be used to relax bands of the neck from a muscle called the platysma, leading to a smoother effect.  Fine horizontal lines can be treated with Belotero Fine Lines, a hyaluronic acid that can be placed more superficially in the skin.  Skin tightening procedures such as the Exilis and Protege Elite radio frequency devices can tighten with no downtime, while the Ultherapy device is approved for up to 12 months of skin lifting in the neck area.  Pigmentation and sun damage to the neck can be treated with IPL and skin tone be improved with minimal downtime using ResurFX.  For heavier sun damage and skin texture changes, the fractionated CO2 laser ECO2 can be used to rejuvenate the neck skin.  Many of these can be combined together, with an appropriate treatment plan outlined by myself.

For further information or to enroll in the Kybella CONTOUR study, contact Art of Skin MD at 858.792.7546.