Kybella; no results. Did it 5 weeks ago? Chin fatter than before? (Photo)

Question

i had kybella done 5 weeks ago...the area still has some hardness and is fatter than before i had it done! i had two viles with lidocaine mixed..i had very little fat to begin with but i am hoping this hardness isn't permanent..im noticing the hardness is not changing..

Lillian Overman, MD · Answer

We have become accustomed to fast and dramatic changes with Botox and fillers. Kybella is different. 
Kybella's timeline after injections is something line this....
     2 to 7 days of swelling obvious to everyone (for me this was 4 days)
     weeks of swelling obvious to the patient and physician (for me, this was about 12 weeks)
     Very subtle changes of tightening along jaw line starting around 5 to 6 weeks after first injection
     Palpable lumps in injected area up to around 12 weeks
     Little improvement in submental fat pad after the first treatment, even after swelling resolves
     4 to 8 weeks after second treatment, patients start to notice a reduction in the fat pad 
     Around the same time, patient note that their jawline is crisper
     I haven't met a patient yet who was particularly impressed after the first treatment
     The thrill occurs after the second treatment.
Hoping that you will be happy with your results in the long term.

Nirmal Nathan, MD · Answer

Hi there. It is hard to say base on the photo you sent. Your injector should have counseled you regarding the treatment course and common side effects related to Kybella. In most patients, at least 3 treatments are necessary for optimal results. Of course, depending on how much fat you have, less or more treatments may be necessary.

Swelling is to be expected, and usually resolves over 2-4 weeks. Sometimes this can last longer. Depending on the dose, fat necrosis can rarely develop, but this usually happens on a longer timeframe. This would appear as a small nodule.

Less common side effects include temporary nerve paralysis and skin ulcerations. Someone who has a good knowledge of facial anatomy, such as a board certified plastic surgeon can help minimize this risk. Always make sure your injector has the appropriate qualifications and has a good understanding of the product.

What you are describing sounds like persistent swelling, and should resolve over time. I would return to you injector for evaluation. Hope this helps.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  Though the angle of your chin will worsen the appearance of retained adipose tissue Kybella often requires a series of treatments to improve the chin region - recommendations call for 3-4 sessions.  I would discuss your anticipated plan with your injector to have the best treatment plan made.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question ahersh512. I am sorry to hear about your
situation. Kybella is the first and thus-far only FDA-approved non-surgical
injectable treatment for the double chin. Induration or hard lumps is a possible side effect of Kybella and normally goes away on its own over weeks. For my patients I recommend at least two treatments spaces 2-3 months apart. We assess the results 2-3 months after the second treatment. results are seen slowly and patience is important. Please consult with a doctor for specific recommendations. Good luck!

Kouros Azar, MD · Answer

Every patient heals differently. While for most, the swelling following Kybella clears up in a couple of weeks, for others, it can take a couple of months. Continue to be patient and kind to yourself. If you still are unhappy with your results at 8 weeks post op, make an appointment to see your injector.

Paul Pietro, MD · Answer

Hello ahersh512,Thank you for your question and photo. Kybella is very effective at permanent fat removal under the chin. Although most will have the swelling subside by two weeks post treatment for some it can last up to 8 weeks. Additionally the recommendation for moderate to severe fat pockets is 2-4 treatments in order to see the results you desire. The little hard nodules are actually a good sign that the treatment is working for you in that they are a result of the inflammatory process created by Kybella. Give it a little more time and discuss fully with your treating professional. Good news is that with subsequent treatments the symptoms you, as well as others, will be less intense.

Shaun Patel, MD · Answer

Almost certainly you have some swelling post procedure and this is normal. The hardness/induration is related to the inflammatory process caused by the Kybella and this suggest that the Kybella is still working. Both the swelling and hardness can take up to 6-8 weeks to resolve and is not something to be concerned about. Kybella is the 1st FDA approved injectable treatment for the fat below the chin and it is very effective. Most patients required 2-3 treatment sessions spaced at 2 month intervals. Usually, 4-8 vials of Kybella are used over the 2-3 treatment sessions. The point is, the Kybella appears to still be working in your case, and 2 vials will likely not be enough for you. These are all points that your injector should have discussed with you prior to treatment. Nonetheless, I would followup with your injector to discuss your concerns and to come up with a plan going forward. Good luck.

Sameer Bashey, MD · Answer

It is not uncommon to get swelling under the chin/neck area after kybella is injected. Some patients don't respond much to the first treatment but respond more vigorously to the second or third session. Kybella does do a great job of reducing the double chin in the right patient and I have had great experiences with it. In fact, I like it a lot more than coolsculpt for the chin and I am seeing more and more patients opt for Kybella rather than neck/chin liposuction.

Kevin Cavanaugh, MD · Answer

Hi,
Thanks for your question and sharing your photo. I'm sorry you are frustrated with your results. I would encourage you that swelling after Kybella lasts several weeks and final results (both fat loss and skin tightening) are not seen until around twelve weeks. We do not see our patients in follow up for a potential second treatment until twelve weeks after injection. We also do not inject fewer than four vials in our clinic. I would wait it out and see your injector at the twelve week mark and review your before and after photos prior to discussing your next steps. I hope this is helpful!
Kevin Cavanaugh, MD

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting your photos.  Generally speaking, most patients experience swelling for up to 2 weeks after Kybella injections.  However, some patients can experience swelling for up to 2 months.  I also find that swelling tends to last a little longer in patients after their first treatment.  The hardness you're feeling is actually a good sign - the fat cells destroyed by Kybella actually form hard knots under the skin before they are naturally excreted from the body.  Initial results are typically visible at 6-8 weeks, though I find many patients don't see their final results from a Kybella treatment until 10-12 weeks after treatment.  I'd recommend following-up with your injector to discuss your concerns.  Best of luck!

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