Milan Lombardi, MD

As a cosmetic dermatologist I see several patients a month requesting removal of these lesions.  It is important to take skin tone into consideration when developing a treatment plan but most patients can be treated with a simple in office procedure that does not involve any cutting or painful after care.  Essentially we melt or vaporize the lesions while taking care to not damage the surrounding skin.  I numb everyone beforehand so there is no pain felt during the procedure.  Be careful with at home remedies found online, none of them will work and some can cause damage to that area, the skin on the genitals is some of the thinnest skin on the entire body.    

Fantastic question as temperature does affect the rate (or speed) of many chemical reactions in the body.  While it may be possible that lowering the temperature could affect the rate at which kybella breaks open the cell membranes of fat cells, it is not a clinically relevant temperature change for this procedure and icing will not lessen your results.  Almost all kybella treatments come with some degree of swelling and inflammation and icing will help lessen this.  So icing is your friend, but don't consider combining kybella and cool sculpting in a single session as tempting as that may sound.  Enjoy your results.

    This is a great topic and I find many patients asking this question in general.  As a rule of thumb, if you don't feel 100% comfortable with a procedure it is in your best interest to seek a second opinion.  You should always feel confident in the physician you have chosen to perform any elective procedure.  Each doctor will have different reasons and conditions under which they may perform a procedure to get the best result.  Personally I remove lipomas under local anesthesia, but some lipomas on the forehead are under the muscle and lie just above the frontal bone of the skull.  These are called subfrontalis lipomas.  They can be trickier to remove and some surgeons may choose to remove them in the OR.  
  Currently there are no great alternatives but the fat dissolving product deoxycholic acid is finding a larger role in eliminating unwanted fat in areas of the body other than under the chin, which is where it is currently FDA approved for use.  If you are unsure about having an operation consider waiting for a few years, technology and research in the field of fat removal may provide you with a more reasonable alternative.  
   

This is a great question; many people don't know that certain lasers can indeed remove unwanted veins from around the eyes, temples and lower forehead.  They are called periorbital veins.  The Nd:YAG laser is unique in treating such veins because it can both penetrate deep enough to reach the vein and target the bluish/purple color of it.  However, because of its ability to penetrate deeply it must also be used with caution around the eyes.  I have successfully treated patients such as yourself using an Nd:YAG laser by placing eye shields over the eye and pulling any veins to be treated outside of the orbital rim (the bony portion of the eye socket).  You can expect some swelling to occur in the area treated and a mild-moderate but easily tolerable amount of discomfort during the procedure.  The vessels should completely disappear and the darkness under the eyes may improve somewhat although based on your picture further treatment with a filler such as Restylane or Belotero may be needed to improve your tear trough area.  A board-certified dermatologist or core aesthetic physician who specializes in lasers and cosmetic procedures should be able to properly evaluate in person how much you will improve with an Nd:YAG treatment and fillers respectively.  Good luck!