Treating the double chin: Kybella versus liposuction.

Since its approval by the US FDA for treatment of moderate to severe submental fat in 2015, Kybella has received significant media attention as a nonsurgical alternative for treatment of the double chin. 

Kybella, or deoxycholic acid, is a bile acid that destroys fat cells. When injected into an area with fat, an inflammatory reaction occurs as the body cleans up and removes the byproducts of the fat breakdown. Kybella treatments typically require multiple sessions, and usually the greater amount of fat present the greater number of sessions are needed for satisfactory fat reduction. 

Just because Kybella is a nonsurgical treatment does not mean it doesn’t have potential complications. In a pooled analysis of Kybella clinical studies, Dr. Kridel and one of our former fellows, Dr. Patel, found that a significant number of patients reported pain, swelling and numbness after their injections. These reactions were the result of the inflammatory reaction caused by the bile acid. When the inflammatory reaction occurs near a nerve, nerve function may be temporarily impaired. The main concern that we have with Kybella is that patients have to experience these potential side effects after every treatment session, and even patients with mild fat depositions need several sessions. 

The overall cost from Kybella should also be considered. In the same study, Dr. Kridel found that Kybella clinical trial participants received an average of 186 mgs of Kybella. Since Kybella is sold in 20mg vials that cost the consumer on average $691, then 9 vials of Kybella would cost $6,219. Comparatively, the average total cost for submental liposuction in the US is approximately $3,000. 

Although clinical trials have shown that Kybella can effectively reduce fat, the need for repeated injections and the large volume of drugs necessary to achieve the desired results makes Kybella not a very cost-effective treatment. Perhaps the only situation where Kybella can be a financially viable option for reducing submental fat is for individuals with minimal submental fat who would benefit from 20 to 30 mg of Kybella per treatment for a series of 3 sessions. While there is a greater up-front cost for submental liposuction, the need for only one treatment and the overall long-term cost savings makes it easily the better option. 

Patel S, Kridel R. Current Trends in Management of Submental Liposis. A Pooled Analysis and Survey. JAMA Facial Plast Surg. doi:10.1001/jamafacial.2017.1567. Published online October 19, 2017.