Adam M. Rotunda, MD

Mohs surgery attempts to preserve anatomy and function. Mohs is the preferred treatment for the removal of malignant skin tumors growing on the eyelid.  Your Mohs surgeon will be able to give you a sense of potential eyelash loss; this depends on the depth and surface extension of the tumor.  The base of the eyelash, the seed from which it grows, may be affected during the surgery. If this hair 'seed' is damaged, then the lash will no longer grow. Otherwise, there is a very real possibility that the eyelash will continue to growth after surgery.  Best of luck and health, Doc Adam

Thank you for your message.  While it appears a little rigid to use a grid and keep the injections in a confined space, there are some pretty legitimate safety reasons for this. The original studies into Kybella involved thousands of patients with, as you could imagine, many different size necks. In order to look exactly at the effect of the injections on the neck fat, the investigations had to standardize the injection technique (where and how and how much of the medicine was injected) across all of these study patients.  It was determined that using a grid and fitting the grid on a relatively small area on the neck was the safest way for the injections to be administered.  We learned that the critical area to avoid was the marginal mandibular nerve (it controls the lower movement of our mouth) approaches the upper layers of the skin.  Injectors of Kybella and Belkyra are taught how to avoid harming the nerve, which essentially means sticking to proper grid placement.  However, now that the product is being used outside of clinical trials, there is a little more freedom for tailoring the treatment to each patient's neck.  The grid and recommendations by the company where to inject are starting points; if your injector is comfortable with the anatomy of the area and the path of the marginal mandibular nerve, he or she may have more freedom in tailoring your treatment for you.

Hi there - thank you so much for your question! Yes Kybella works, and it works very well. The satisfaction rates after treatment are very very high as well.  With only photographs I cannot give a completely accurate sense of whether you are an ideal candidate for Kybella, but from what I see you have very little loose skin (that's ideal for Kybella) and an amount of fullness that would reduce significantly after a compete course of Kybella. Generally at least two treatments of Kybella are required to see any type of result and for the amount of fullness that you photographed I think you'd need four and possibly five treatments, each spaced 4-8 weeks apart. There is downtime like swelling and tenderness and Kybella is a 'slow and steady' approach to reducing submental fullness and as such you have to be a 'patient patient.' But it's also minimally invasive - no surgery. I will have to defer to my other colleagues on this site to answer the 'liposuction or neck lift' part of your question - I don't perform those. Of course surgery is an option for most people as a way to reduce neck fat, but the concept of having a more invasive procedure is increasingly viewed as 'a last resort' after you consider all other options.  Surgery is very effective and gets the job done quickly and very well, but depending on your expectations and needs, a less invasive option may suit you. Best of luck, Doc Adam

Thank you for your question! So glad you are receiving the outcome that you've expected with Kybella. While the answer will ultimately be up to the physician injecting you, treatment a week 'early' would be reasonable.  While this approach is different than the four week intervals used in the clinical trials (as you point out as 'standard'), injection interval is ultimately decided by the patient and physician, as this is a very tailored treatment in general.  Increasingly, patients are being treated every 6 to even 8 weeks, and results generally improve up to 3-6 months after treatment.  This is because although there may not be any any visible swelling or signs of residual healing at 4-6 weeks, recovery is still taking place beneath the skin. However, shortening the treatment by one week in your particular case, for only one treatment period would in my opinion and experience be reasonable. The fat destroyed by Kybella is relatively immediate (within minutes to hours), the subsequent swelling that takes place is necessary for the fat to be replaced with healed tissue.  If you have residual fat (don't we all!), it will be removed with another round of Kybella, regardless of whether it's early.  In the early early phases of developing Kybella, I am aware of the treatments every 2 weeks with much higher doses than what is now recommended; while I am not advocating that, it does signify that there are variations in treatment regimens that may be just as effective (or more than!) what we are currently doing.  Doc Adam

Off label use of pharmaceutical drug is the use of a drug in an unapproved age group, dose, or route of administration.  Kybella is approved for the reduction of fat under the chin in adults.  While it is at the physician's discretion to use a medication off-label, I think you would be hard pressed to find anyone willing to inject Kybella in the area that you describe.  Kybella can be used off label anywhere there's a relatively small amount of fat, but patients and physicians must understand that the risks and benefit of using it anywhere outside the submental (under chin) location are unknown at this point in time.  To my knowledge, Kybella has been used off label with good success around the bra strap area (upper back), inner thighs and knees and for small pockets of abdominal fat.  I personally have not tried it in these areas, nor have I seen any controlled clinical trials revealing the risks and benefits of doing so (as in any procedure, 'success' depends on whether the benefits outweigh the risks), so I am hesitant to broadly recommend it in those areas.  Specifically for you, swollen or thick ankles may result from numerous reasons, not just excess fat, and therefore Kybella would not be the answer for you.