Kybella is actually a chemical called deoxycholic acid.This acid is naturally made in the gallbladder and is released into the stomach when we eat fatty foods. They have found a way to synthesize this acid for use in cosmetic medicine. The most common side effects are bruising, pain, swelling, numbness, tingling and itching. Why do we get these reactions? First of all - it's injected into the fat cells using needles - this can result in bruising. Secondly, the "job" of deoxycholic acid is to break down the fat cells, so the body's response is to flood the area with all sorts of cells and chemicals that are essentially "cleaning up". This is why there is swelling. In addition, the swelling can press on some of the sensory nerves in the area and this can result in tenderness [pain], tingling and even itchiness. The side effects are usually most severe in the first 72 hours, depending on the person - some swell more than others. I always recommend icing 20 minutes on and 20 minutes off at least 3-4 times per day in the first 72 hours and then application of Alastin TransForm Body Treatment cream immediately after icing. Alastin TransForm Body Treatment has been shown to help the body clear the fat cells and hence the bruising and swelling MUCH faster than just icing alone. For most people, the area continues to be swollen, numb, and "tingly" and even tender for up to 6 weeks after the treatment. I have found this to be shortened to only 2 weeks when Alastin TransForm Body Treatment cream is used. As for massaging the area, most people tell you not to massage the treated area. Why? In general, massage can cause more trauma to an already traumatized area, but more importantly, in the study performed to gain FDA approval, they found that massage wasn't helpful. I, on the other hand, encourage my patients to massage the area once it is no longer painful, generally this is after the 72 hours. In my practice, this gentle massage combined with the Alastin TransForm Body Treatment Cream seems to help the sensation recover more quickly and the "lumpiness" that sometimes occurs to smooth out. Hope this helps!