Written by Dr. Paul M. Graham
In April 2015, the FDA approved the use of a novel medication known as Kybella for the treatment of submental (underchin) fat. This medication is identical to a natural substance called deoxycholic acid found in the gastrointestinal tract of the human body. Deoxycholic acid is a bile acid that is produced as a byproduct of intestinal bacteria and works by dissolving dietary fats in the digestive tract for easy intestinal absorption. Kybella is an injectable deoxycholic acid solution that functions similarly by destroying fat cells when directly injected into the fatty layer of the skin (subcutaneous layer). Upon injection, this product physically ruptures the cell membrane of the fat cell (lipocyte), leading to permanent destruction and elimination of the fat collection over a series of treatments. 
Treatment with Kybella involves a series of steps prior to the injection, including prepping the skin, determining the specific injection sites using a grid overlay, and the application of a topical anesthetic medication prior to the procedure. Oftentimes, patients can expect to receive 35-50 injections in a single treatment depending on the specific size and location of the submental fat collection. It is often recommended to undergo 2-4 treatments separated one month apart for best results.
Side effects from the treatment with Kybella are often well-tolerated but should be thoroughly understood prior to undergoing this procedure. The most common side effects include moderate burning, swelling, bruising, and numbness at the treatment site immediately following the injection and lasting up to five days. The burning sensation can last up to 12-24 hours following the treatment session. After the swelling subsides, the area will feel firm to the touch. This firmness often last up to 3 weeks following the treatment.
A rare, but serious side effect is marginal mandibular nerve injury. Injury to this nerve may lead to the development of prolonged numbness, asymmetric smile, facial muscle weakness, and/or difficulty swallowing. The good news is that if this does occur, it is often temporary with resolution over six months. This is an important reason why this procedure should only be injected by a licensed, board-certified dermatologist or plastic surgeon.
Kybella should never be injected anywhere outside of the FDA recommended treatment area (submental/underchin fat), but research is currently underway to look at ways to eliminate fat tissue elsewhere on the body using this medication. Also, Kybella should never be injected into sites of active infection or in patients that have had previous surgical procedures to the neck region.
Personal Experience:
I use this product in our practice and have had very good results thus far. I do recommend that patients commit to at least 2-3 treatments in order to see noticeable results in fat reduction. I also thoroughly inform each patient about the intense inflammation that is expected after the treatment session. Topical anesthetics and ice packs to the treatment area prior to injection often lead to decreased pain during the procedure. I routinely give icepacks following the treatment and recommend application for 15 minutes every hour for the first four hours following the procedure to decrease this discomfort. If the burning sensation persist, I often recommend taking over-the-counter NSAIDs (Ibuprofen or Tylenol) as tolerated. I do explain that these medications may increase the appearance of bruising.
Overall, I really do like this product and truly believe in the results that it offers to my patients. This procedure causes permanent destruction of fat cells (lipocytes), which is a huge plus for this product. This diminishes the need for more invasive surgical liposuction procedures. Despite the excellent results with Kybella, it is very expensive and should only be considered in patients that are willing to commit to a healthy lifestyle. Incorporating a good diet and exercise regimen should be a priority in order to preserve the results of this highly effective, non-invasive procedure.
Stay tuned for Part 2 of this article as I will be demonstrating an experiment that I conducted using Kybella solution with in-vitro fat tissue. I will demonstrate how Kybella physically works under the microscope with several before and after photos from this experiment.
Photo Credit: MyKybella.com, Utahfacialplastics.com, Prpcosmetictreatments.com, Allergan
References:
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm444978.htm
- https://pubchem.ncbi.nlm.nih.gov/compound/deoxycholic_acid
- https://hcp.mykybella.com/about-kybella/mechanism-of-action
- http://reference.medscape.com/drug/kybella-deoxycholic-acid-999993
- http://www.allergan.com/news/news/thomson-reuters/kybella-injection-wins-allure-magazine-best-of-bea
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