Off label kybella for jowls to firm or define jaw line? (photo)

Question

I had my 1st kybella treatment today for the jowl area. I was nervous because I know this area can result in nerve damage but my provider said they've seen great success with treatments to jowls. Because it's off label, I'm finding it difficult to find reviews/results. For those drs who have confidently used Kybella in the jowls, what results can I expect? I had 5 injections on each side. I'm hoping to reestablish a stronger jaw line. I plan to have my small double chin treated as well. Age 45

Sabrina Fabi, MD · Answer

Kybella does a wonderful job of melting excess fat in the jowls with deoxycholic acid. Yes, it is an off-label use, but as long as you are being treated by a medical doctor who has knowledge of anatomy, there is no cause for concern. I have used Kybella many times to remove the small pouches of fat that occur when someone first begins to develop jowls. It's a very effective treatment, as the fat loss is gradual so that the skin has time to adjust. Kybella also has a slight skin-tightening effect, which will help to rejuvenate your jawline.However, if your skin is inelastic to begin with, you may need co-treatment with Ultherapy. You will probably need at least two to three more sessions of Kybella to get the kind of defined improvement you are seeking. Consulting a board-certified dermatologist who has a lot of experience with Kybella will help you feel more at ease with your treatment. We are always happy to answer your questions.

Cameron Chesnut, MD, FAAD, FACMS · Answer

Kybella is a dynamic product with broad capabilities, including off label and off the face. It truly is surgery in a bottle, with permanent removal of fat - the main alternative treatment being liposuction. 
I have always used Kybella to not just treat the area directly under the chin, but to blend it in to the lateral neck and jawline. This yields a more natural and thorough treatment. The only time I use the cookie cutter grid is when I am teaching other physicians how to use it,  which you can see in the attached video.
With the ability to treat broad area, it is easy to customize a Kybella treatment to match your exact goals, needs and anatomy. It can take multiple treatments, but I tend to get towards final results after two treatments, and the second treatment can be even more custom tailored to achieve that final result. Liposuction can achieve results with one treatment, but does not allow for the fine-tuning when needed, so which treatment will be best for you will depend on a discussion with your surgeon.
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Nelson Castillo, MD · Answer

Thank you for sharing your question.  If you understand the benefits and risks of treatment, Kybella can be injected into the jowls in an off-label manner to obtain a noticeable improvement in jawline definition and contour.  I have had good success with treatment as a part of an overall facial rejuvenation program.  Be sure to see an ASPS board certified plastic surgeon.  Hope this helps.

Nana N. Mizuguchi, MD, FACS · Answer

You are correct in stating that Kybella is off label when treating the jowls.  While products are often used off label, I do not recommend the use of Kybella in the jowl area for two reasons.  First, the mandibular nerve runs along the jawline, and if the Kybella were to affect this nerve it can lead to damage and an asymmetric smile.  Second, jowls are typically the result of skin laxity rather than fat tissue.  Kybella targets fat cells, so treating the jawline with Kybella is typically ineffective since there is little fatty tissue and more skin laxity.  Consult with your injector to ensure optimal outcomes.

Falguni Patel, MD, FACOG · Answer

hi, this is not an area I have treated and therefore am intrigued as to how you will do.  Having said that, I noticed the sides of your lips are turned downwards, indicating to me that you likely have mid face volume loss.  If you don't address the mid face with fillers then no mater how much fat you remove lower down, I don't think the "bounce up" will be as dramatic.  Combination of ultherapy and or fillers would be a fabulous result.

Roberto E. Garcia, MD, FACS · Answer

Kybella, as you know has not gotten FDA approval for the Jowls.  Thats not to say that it cannot be done, just that there have not been sufficient studies to clear its safety and efficacy.There is  a much higher risk of nerve injury with jowl injections, but if your injector knows the anatomy, then you should be ok.Please post the before and after pics after your 3rd treatment.

Jason Emer, MD · Answer

I recommend a combination approach for the jowl area. I recommend fillers for the jowls themselves and to provide anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments and peels to get the most conservative natural look. 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 an alternative for contouring the chin, if you're a candidate. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Michele S. Green, MD · Answer

Kybella is a great FDA approved injection for submental fullness.  The problem with treating with the jowls is that full studies have not been determined and you run the risk of the unknown.  We use a great deal of Thermage for this area to tighten the jowls and help with skin tightening as well as the use of fillers to help this area.  Please consult an expert in non-surgical skin tightening.  Best, Dr. Green

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank your for your question and for submitting your photos.  You are absolutely correct - Kybella is currently only approved by the FDA for treating submental fat (fat under the chin) and any other treatments are considered "off label" at this time.  This is not necessarily because Kybella is not effective in other areas; rather it is because there have not yet been sufficient studies to demonstrate its safety and efficacy in other areas to the FDA.Kybella can be used in the jowls with excellent results, but this is a higher risk injection that requires extensive knowledge of facial anatomy, as the there is a risk of damaging the marginal mandibular nerve in this area.  Best of luck!

Zein E. Obagi, MD · Answer

Kybella is designed for the submental area with a 1-1.5 cm inferior to the bone of the mandible and chin. This is for safety. If it is injected to high or too lateral it can damage a portion of the facial nerve that controls the lower face. Although, this damage is not permanent it can be present for many months. While off-label use of Kybella is increasing in popularity- I would only consider this in anatomically safe areas

Off label kybella for jowls to firm or define jaw line? (photo)

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