What can be done about sagging skin after first Kybella treatment?

It would be helpful to see photos so that I could evaluate how much sagging skin you have. When we were testing Kybella, we noticed that in many instances the skin under the chin tightened a bit. However, the degree to which this occurs is dependent upon the patient's skin quality and amount of sagging before the procedure. Removing the fat can sometimes leave the skin looking looser than before treatment. I try to head this off from the beginning by advising a patient with loose skin to get combination treatment with either ThermiTight or Ulthera. If your board-certified dermatologist did not offer you combination treatment at the beginning, you can still benefit from it now. It is not uncommon to need more than one kind of treatment to get a particular result. Consulting your board-certified dermatologist will allow you to explore your options.

Kybella does what it's supposed to do - and that's dissolve fat. The overlying skin then has less volume behind it and if you already have sagging skin, the risks of seeing more sagging can be high if you have lost a lot of your skin elasticity.Doctors usually explain that Kybella is a single action procedure (fat reduction) and not a neck tightening procedure. Some patients do get a contouring effect as a result of the inflammation that is part of the procedure action, but it's not a guaranteed effect. There are skin tightening treatments that may work to improve the skin sagging, but again, if your skin is excessively loose, even those treatments may not be sufficient and your most effective option could be surgical in nature.

Thank you for your question about Kybella.It is difficult to accurately treat without assessing in person.  However, depending on multiple factors, the amount of fat, age, smoking history and so forth, it is not uncommon to have sagging skin. Our office offers Exillis for skin tightening.  There are multiple options for skin tightening as well, depending on the amount of excess skin. 


To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.

I hope this helps.

Kybella is good for dissolving fat under the chin, but a combination approach is needed to get the most improvement with non-invasive options. I recommend a combination approach with thermage, ultherapy, exilis. VASER liposuction in combination with ThermiRF is the best alternative for contouring the chin and can be performed with a neck lift, if you're a candidate. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Dear aklepich,Kybella typically takes 3 to 5 treatments to work. This is why I've stopped carrying Kybella in my office.  I recommend neck liposuction more often then any injectable procedure for the neck now. It provides superior results gives me more control over the area than any injectable.  It also costs about the same as what you paid for your first kybella session. The liposuction can be done under local while awake in the office and recovery is about the same as kybella.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

After a Kybella treatment, it’s common for the treated area to experience swelling and some sagging skin. Here’s what can be done to address sagging skin:1. Patience: Swelling and sagging are typically temporary and should subside within a few weeks after the treatment. Give your body time to heal.2. Consult Your Provider: It’s essential to communicate with your Kybella provider. They can assess your specific case and recommend the best course of action.3. Additional Kybella Sessions: In some cases, additional Kybella sessions may help improve the appearance as it continues to break down fat.4. Combination Treatments: Some patients benefit from combining Kybella with other skin-tightening procedures, such as Venus Freeze, Venus Viva or other laser modalities that can target loose skin non-surgically.5. Topical Creams: Your provider may recommend specific skincare products to help tighten and hydrate the skin.6. Maintain a Healthy Lifestyle: Staying hydrated, eating a balanced diet, and avoiding significant weight fluctuations can also help maintain the results.

Without examining you in person, it is impossible to give you a truly accurate response. The problem with Kybella and sagging skin is that if the skin was lax before treatment and then you remove the excess fat then, obviously, the situation is worse. If you are only interested in non-surgical options then you are going to need to combine your Kybella treatments with some sort of skin tightening procedure such as Profound RF or Thermage or Ultherapy... there are quite a few options. 

Thank you for your question aklepich. I understand your concern. Kybella is the first
and thus-far only FDA-approved non-surgical injectable treatment for the double
chin. The double chin can be formed by various factors including age, weight
gain, and genetics.It is difficult to make an assessment without a
formal exam where I could examine the skin or at least photographs. Also you did not state how many treatments were performed, how many vials were used per treatment, and the intervals between treatments, important information required to make a good assessment. Your injector would have all of this information and would be best suited to make an assessment and recommendations. However I hope that the information provided here is useful.The active ingredient in Kybella (deoxycholic
acid) is used by the body to digest the dietary fat. When injected into
the double chin it will dissolve the fat and it is eliminated by the body
naturally over time. The pivotal studies demonstrated that most
people require two to four treatments, sometimes up to six treatments. The
pivotal studies used two vials per treatment, which is what I use for my
patients. Some doctors use more or less than this amount, which is fine. Although in the pivotal studies treatments were
performed at four week intervals, I find that performing treatments at twelve week
intervals provides for better results. This may be due to an increased amount
of time for healing of the skin, allowing nodules to dissolve and swelling to
completely subside. Therefore, I recommend that patients start with one
treatment, followed by a second treatment three months later, and return three
months after that to assess initial results. At that point, more treatments may
be performed if further enhancement is desired. Patience is important.With any injection, there is a risk for pain,
bleeding, bruising, redness, tenderness, swelling, and infection, We take
special precautions to minimize these risks. We numb the skin prior to the
treatment and apply cold air to maximize our patients' comfort. We treat
bruises with a laser as early as the next day. Bruises usually resolve by two
weeks and after a laser treatment they usually resolve in one to three days,
although it still can take up to two weeks for full resolution. Most people
feel a burning sensation for about 15 minutes after the treatment. This is
addressed by placing cold compresses on the area which we provide in our
office.The most common concern for our patients after a
treatment is swelling, which occurs 100% of the time and I feel that this is an
indication that the treatment is working. I tell my patients to expect swelling
for one to two weeks. Some people describe it as looking like a pelican or
bullfrog. Therefore, patients prepare for this by scheduling their treatments
at times where they are not planning any special events where they want to look
their best. Some people will wear a turtleneck or scarf during this time to
hide the swelling. For my patients, I recommend applying cold compresses such
as ice packs to the area to reduce the swelling. We provide cold compresses
which can be frozen and re-used which attach to a wrap that goes around the
neck and crown of the head. Also sleeping on an extra pillow if not
uncomfortable will help to reduce the swelling.A common question with these treatments is the
issue of loose skin left over after the fat is removed. The possibility of
loose skin after such treatments is logical. I have found that patients do not
have loose skin left over after Kybella treatments. This is likely because
there is an inflammatory reaction after the treatment as evidenced by the
swelling. This inflammation may stimulate collagen formation in this area. This
will prevent loose skin and wrinkle formation in the skin overlying the fat
which was removed. Therefore it is unusual to hear about this. Again it is difficult to make an assessment without photographs. However, for my patients with loose skin I recommend fractional CO2 laser resurfacing. This stimulates collagen formation and tightens the skin as described below.Those interested in Kybella treatments for the
double chin are usually also interested in improving jawline definition. While
Kybella, Cool Sculpting Mini, and liposuction all improve jawline definition,
there are other treatments that can be performed to further improve the jawline
definition. Fillers such as Voluma can be placed on the jawline or in the chin.
This will sharpen the jawline. Such fillers can also be placed in the upper
cheeks to restore lost volume to the mid-face. This provides the structural
support for the face that is slowly lost over time. As a result, this will pull
up on the lower face to improve the jawline definition. Simultaneously it will
restore the youthful apple of the cheek and address nasolabial folds (the
wrinkles that go from the sides of the nose to the corners of the mouth),
marionette lines (the wrinkles that go from the corners of the mouth to the
jawline), and jowls. Skin tightening treatments such as fractional CO2 laser
resurfacing can stimulate the skin to form its own natural, new, fresh, and
healthy collagen. This will tighten the skin and pull the lower face upward. Finally,
Botox can be placed in the platysma muscle in the neck which pulls down on the
lower face. When this muscle is relaxed it will lead to a subtle lift of the
jawline further improving the definition. Combinations of such treatments yield
improved results.Please consult with a doctor for specific
recommendations. Good luck!

When I do Kybella, I also use Fotona Laser skin tightening on the same day.  This also heats the fat and make the Kybella treatment more effective.

I am sorry to hear that you have some loose skin in the area after receiving Kybella. In my experience, this rarely happens with a single treatment but it depends a lot on your underlying skin quality. There are some relatively non-invasive treatments that can be done to help tighten your skin - ultherapy is one, and thermage is another. These have varying degrees of effectiveness and your Plastic Surgeon can tell you more about them. I would suggest having a conversation with your Plastic Surgeon and asking to see your before and afters, and then go from there regarding costs. Best of luck!