Kybella concerns: 11 days post first treatment. 4 vials injected. Advice? (photos)

Question

My concerns are: 1) was the kybella injected too high on the side of my jaw? It was 1 full vial. I dont want to have a drastic change or look like I had buccal fat removal since i only wanted have a sharper jaw/under chin. 2) do i risk a slight chance of permanent damage with my crooked lower face?

P. Daniel Ward, MD · Answer

The marginal mandibular branch of the facial nerve appears to have been affected by the Kybella. This is almost certainly temporary and will improve on its own with time. You may want to consider having your doctor inject some botulinum to the opposite side to even things out while you wait for the nerve to recover.

Jason Emer, MD · Answer

I recommend following up with your Doctor. It appears the nerve may be impaired, but this is most likely temporary. It will take several weeks for final results with Kybella. A combination approach is needed to get the most improvement with non-invasive options like Kybella. I recommend Kybella with thermage, ultherapy, exilis. VASER liposuction in combination with ThermiRF is a great alternative for contouring the chin, if you're a candidate and can be performed at the same time as a neck lift. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Kenneth D. Steinsapir, MD · Answer

This is precisely how you are marked.  Unfortunately Kybella causes a lot of inflammation and it is well described to cause a motor nerve injury.  Your photo demonstrates a marginal mandibular branch injury.  The good news is that these generally recover.  The bad news is that they don't all recover.  Kybella is a big bummer of a treatment.  I think that as a service, it is headed for the trash heap of history.  I would not recommend doing this service again.  Do more homework about services. When you see a lot of negative information about a service, pay attention.  Generally it can take a couple of months for the nerve to recover.  If it does not recover in 6 months, it is not likely to recover.  Your treatment was not in an FDA approved area and foreseeable could cause the injury that you are experiencing.  Please consider reporting this individual to the Calfornia Medical Board to protect others from this type of misadventure.

Richard W. Westreich, MD · Answer

Kybella is deoxycholic acid, a substance that targets fat. Unfortunately, all cells have fat in their cell walls, so it is not specific for "fat" as you know it. Kybella can injure nerves, muscles, and even skin if not injected properly. Kybella should never be injected within 2 cm of the mandible, in order to avoid causing a marginal nerve weakness. It appears that you have this on the left side. While recovery may occur, it is not certain. You should receive nerve stimulation therapy to try and recover function quicker and have botox placed on the opposite side, which was become overactive due to the left sided weakness. Kybella should never be injected into the face above the jawline.For patients with more global facial volume, liposuction is a much better and much safer choice. You should go back to your injector and seek nerve stimulation therapy.

Daniel Barrett, MD · Answer

Dear tania_f,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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Trevor M. Born, MD · Answer

Dear tania_fThank you for your question and photos!  I am sorry for your concern.  If Kybella is placed near the marginal mandibular nerve - it may cause weakness. In cases I have seen reported the nerve recovers  with normal movement.  The  results from Kybella can take 4 to 6 weeks .  Please follow up with your MD.With Warm RegardsTrevor M Born MD

Audrey A. Klenke, MD, FACS · Answer

Kybella is approved for submental fat, under the chin. Some providers inject other areas, but this can run the risk of the damage to your left marginal mandibular nerve as you have experienced. The nerve usually recovers, but it can take months to see full recovery. In the interim, botulinum like Botox or Xeomin to the functional right side can help achieve better symmetry. I would suggest not having the Kybella injected in this pattern in the future, but staying in the submental area as it was intended.

Arvind Patel, MD · Answer

Hello,
First,  I'm so sorry that you are having complications after Kybella. Our clinic has done hundreds of Kybella treatments and thankfully we have yet to see this happen, but injury to the myelin sheath of the nerve is a well known risk of Kybella. Luckily usually the tincture of time is the best remedy for this. Meaning even if you don't do anything this should resolve in 5 months, if not sooner. Doing a light circular massage on the lower face and jaw, along with a healthy diet protocol with lots of Vitamin C and protein, should help your body make the repairs you are surely anxious for. 
From the first photo you uploaded it does indeed look like the buccal fat may have been treated.  Although from the photo with the needle the areas that have been circled (not the dots) do not include buccal fat.  I'm not certain if the injector did all the dots or just the areas that are circled. Don't be scared to schedule a Follow up with your injector to ask.  If the buccal fat has been treated a few Sculptra's can be added to restore lost volume.  But definitely wait a full three months (not 2) before deciding to make any tweaks with filler, you may love it exactly as it is now.  Best of luck

Anteneh Roba, MD · Answer

Kybella was approved strictly for submental fat reduction, what is called double chin. It wasn’t approved for fat reduction above the jaw line. Your crooked flower face should resolve in a couple of months.

Susan Buenaventura, MD, FACS · Answer

Kybella is marketed for submental fat (under the chin).  It is used along the jawline as well but one of the potential problems with this is injury to the marginal mandibular nerve (which you have on the left).  In previous studies, the nerve recovered in several weeks.  Your doctor should address this with you and see you on a regular basis until it is resolved.  In the meantime, as another doctor suggested, your surgeon can put some botox on the right side to even your expression out until it resolves.  If you have this area treated again, it is best to inject more conservatively in this area, even if it takes longer to see the results.

Kybella concerns: 11 days post first treatment. 4 vials injected. Advice? (photos)

Answers (13)

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