Tag Archives: Kybella

Non-invasive Kybella may improve your neckline

Non-invasive aesthetic procedures have come a long way in the last ten years. The American Society of Plastic Surgery’s yearly statistics continue to demonstrate strong demand for procedures such as neuromodulators (Botox and Dysport), and hyaluronic acid filler agents (Juvederm, Voluma, Restalyn). Recently, non-invasive contouring systems that perform the techniques of cryolipolysis, such as Cool Sculpting and radiofrequency skin-tightening Ultherapy, have emerged in the marketplace. Now Allergan has added Kybella to the mix as a non-invasive injectable material to dissolve fat under the chin.

Before and After

Before and After

The key to success with these treatments is consulting a comprehensive center that offers a full array of non-invasive and surgical options, and will direct you to the ideal treatment modality for your unique circumstances. Just as with any medical and surgical procedure, there are appropriate candidates and patients with contraindications.

The most important step to avoid dissatisfaction is to be evaluated by a physician who is properly trained to perform comprehensive evaluation and care for all patients with a particular aesthetic concern.

Board-certified plastic surgeons have the most comprehensive education and background experience to correctly evaluate your anatomy and determine which treatments will yield the best outcomes. The statement “if all you have is a hammer the whole world is a nail” rings true for medical spas and dermatologist offices which only have one option, such as Cool Sculpting or Kybella. Just because a treatment option is non-invasive does not mean it is inexpensive. If you factor in the cost of multiple treatments, it may be as expensive as surgery and still fall short of expectations.

When is Kybella the right choice?

With the current status of the injectable form of deoxycholic acid (Kybella) the ideal candidate must have reasonably tight skin with only mild to moderate adipose excess in the submittal and chin neck angle. The patient should not have a significant mandibular jaw discrepancy with the midface or have a particularly steep mandibular plain angle.

When is Kybella the wrong choice?

Any patient with lax skin of the neck or a significant deflation of the neck related to weight loss with demarcated platysmal bands is not a candidate. Taking away fat in this circumstance only worsens the deformity. Any patient with a deep underbite and a small chin with a very oblique chin-neck angle should also avoid Kybella. Deoxycholic acid is mostly created to dissolve fat but does produce some inflammation with the caustic material to encourage collagen production and skin retraction. Skin excess with an oblique chin neck angle and recessed chin will not yield overwhelming positive results.

Instead of Kybella, the better option is placement of a chin implant (genioplasty) with aggressive liposuction to encourage skin retraction. A middle facial third with significant skin excess and deflation combined with loose-hanging skin with platysmal bands is best treated with a corset platysmaplasty in conjunction with a neck/face lift.

Non-invasive aesthetic procedures can be a wonderful adjunct to helping people age gracefully with limited down time. Kybella in the right situation may improve necks and make people happy with the results.

Avoid being pushed into this option without a thorough three-dimensional analysis of your face to determine if it’s right for you. Nothing is more frustrating than spending a great deal of money and not realizing your desired results. Even with surgery, some deformities may not be able to be corrected. Take advice from a board-certified plastic surgeon to maximize your goals and to feel good in your own skin.

Why are Plastic Surgeons uniquely qualified to perform facial analysis and rejuvenation

Board certified plastic surgeons have a very diverse training experience because we do not own a particular body part such as an Orthopedic or an ENT surgeon and we must be prepared to reconstruct or rejuvenate all parts of the body when the demand arises. Those who felt the calling to become plastic surgeons out of medical school realized their gifts and talents that could be offered to patients pertain to their unique skills of three dimensional thinking and artistic perspective to be able to see the problem and formulate a solution no matter how complicated the deformity exists.

I am troubled by the notion that patients think that facial filler agents, neurotoxins, LASERS, non-invasive contouring machines and other technologies or even surgery will work the exact same way no matter who is providing the services. I feel that Madison Avenue and corporate greed is mostly to blame because all aesthetic companies want to sell the product and place it in as many provider hands as possible to deliver their product to the masses. Many products can provide safe, and reproducible results in the right hands but in the untrained provider can result in injuries, poor outcomes and unhappy patients. None of these products are dirt cheap so why go to a clinician who is unable to critically analyze the face or body because of the lack of years of extended training. Remember if you can’t see the problem correctly then you can’t formulate a proper solution. My analogy for this situation is you can give a novice and a true artist the exact same canvas, paint and palate and ask each to create their masterpiece I hazard to guess there will be a distinct difference in outcome and quality. Why risk your face and body or your wallet to chance go to a true trained professional in aesthetic procedures. All providers are not created equal. Plastic surgeon have a unique training and perspective which I can assure you results in better outcomes.

As an example of why I feel uniquely qualified to analyze faces and what can be provided to achieve your aesthetic goals look to my experience as a craniofacial plastic surgeon who spent years mastering the art and science of the rehabilitation of the child with cleft lip and palate. It requires great understanding of the biology of the facial structures of bone, teeth, muscle, skin, fat, and cartilage and how growth and wound healing affects theses structure over time. Typically the child undergoes a lip and initial nose repair at three months of age with or without pre-surgical orthopedic repositioning of the bony segments. Followed by cleft palate repair at age six months to reposition the muscles that move the palate and close the hole between the nose and mouth. The third surgery to repair the cleft of the bone which house the teeth utilizing bone from the hip is performed somewhere around five to six years of age. After a period of six months then the cleft nasal repair is performed to balance the nasal tip with cartilage taken from the back of an ear. Additional surgeries may be required to improve speech function or revise the lip scar. We work closely with ENT’s, speech therapist, orthodontist and pediatric dentist to achieve excellent results.

These principles have been engrained in me and I can apply this knowledge to improving your aging face both non-surgically as well as surgical repositioning of aging soft tissues, changing the shape of your nose, lips and other structures. Please see below pictures of representative cases of cleft lip and palate surgery I have performed over the years. If you have any questions and if you would like a consultation we me and my staff please contact me via our website.

Age three months prior to first surgery
Cleft 1

Age Eight after four surgeries
Cleft 2

Age three months
Cleft 3

Age Eight after three surgeries
Cleft 4

Age three months
Cleft 5

Four months after presurgical repositioning of upper jaw and bilateral lip repair
Cleft 6