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While most people equate fat reduction as part of body contouring it is also relevant to that of the face for submental contouring. Excess fat and fullness under the chin is a common aesthetic concern and many people are bothered by their ‘double chin’ and lack of a better cervicomental angle.

Submental fat or submental lipodystrophy is not particularly amenable to diet and exercise. While it is true that large amounts of weight loss will help improve neck fullness, most people with submental fullness do not need or can not undergo such amounts of weight loss. As a result surgery remains the most effective treatment whether it be liposuction, a submsntoplasty or a lower facelift.

Non-surgical methods of submental fat reduction include energy-based external fat reduction methods or minimally-invasive deocycholic acid injections (Kybella) The use of Kybella is fairly recent being just approved in 2015. It is a medical-grade naturally occurring deoxycholic acid (bile salt) molecule which creates the breakdown of fat cells through an inflammatory process. While the fat cell walls are disrupted the lipids are then naturally carried off and absorbed through normal metabolic pathways. This creates a reduction in fullness under the chin.

Kybella is an office procedure where injections are done in the submental area. The dosage is based on surface area with 2mg/cm2. Using .2ml aliquots a grid pattern is done in the submental area keeping the injected areas 1 cm apart. Up to 10ml of the solution can be given in a single treatment. All patients will require more than one treatment for optimal results.

It is important for the patient to understand that multiple treatments of Kybella will be needed. No results can be guaranteed with just one treatment nor are any clinical results ever shown with Kybella based on just one injection session. How many injections sessions will be needed varies for each patient but they should mentally prepare for 3 to 4 injection sessions to get the best submental contouring result.

The most common and expected side effect of Kybella injections will be the resultant neck swelling that occurs. This will be of some significance and is a reflection of the amount of fat breakdown that its occurring. It takes about a week to go away but it will be noticeable during this time. Postinjection management should include ice and anti-inflammatory over-ther-counter medications. (e.g., Ibuprofen) The use of anti-inflammatory drugs does not appear to suppress the effectiveness of the lipolytic injections.

While injections sessions have historically been spaced apart at one month intervals, I believe this is too soon and is also difficult for patients to have a week of neck swelling every month for potentially the next four months. Longer intervals between injection sessions allows for better patient tolerance and also allows for the full effect of the treatment to be seen. I like to space them 6 to 8 weeks apart. It may take a little longer to get to the final result but it may also the for some patients that they will need one less injection session.

Patients often ask about the use of Kybella for the jowl area, both because of its proximity and a smaller area of fat collection that should be effective. While it is technically an off-label use of the injections I have done it many times and it is effective. The key is to stay out lateral and never inject closer than 1 cm to a vertical line drawn down from the corner of the mouth to the jawline.

Dr. Barry Eppley

Indianapolis, Indiana

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