Kybella in smaller doses - downsides?

Question

Can one do inject smaller doses of Kybella to reduce excessive swelling? If more total number of treatments at smaller doses are administered such that the total volume of Kybella is the same, are there downsides other than additional appointments and trips to the office?

Falguni Patel, MD, FACOG · Answer

Spacing out your Kybella treatments in small increments will prolong downtime and delay seeing significant results. In our practice, we encourage our patients to do more vials in one appointment. No matter how many vials you decide to do with your provider, there is going to be swelling and downtime that lasts several weeks before you will start seeing results. Doing more in one sitting bundles your downtime, requires less office visits and allows you to start appreciating your results in a shorter time frame.

Victoria Falcone, DO · Answer

Kybella use in the cheek area is considered "off label." We often use Kybella for areas on the face but the results are less predictable.
Have you thought about trying to lose weight? Some patients have had great success with use of Semaglutide ( Ozempic) or other medical weight loss options to help return to their ideal weight. You could see an Obesity Medicine specialist in your area to discuss your options. 
If you liked your appearance prior to the weight gain, perhaps a weight loss options can restore your look without risking additional surgery or asymmetry from Kybella use.

Mats Hagstrom, MD (license on probation) · Answer

Kybella is in my opinion a poor choice for reducing subcutaneous fat in the chin and neck area.
In order for the procedure to be effective, it requires injecting sufficient amounts of the product to have a pretty significant inflammatory response.
Even with injecting recommended amount, the procedure is often insufficient to get patients quality outcomes.
The outcome of the procedure is also unpredictable.
Occasionally patients will have a dramatic Response, removing the entire layer of subcutaneous fat leaving patients permanently disfigured.
Liposuction, on the other hand is much more effective, requires one treatment and is much more predictable.
The total swelling after liposuction is less than a single treatment of Kybella. 
Not all plastic surgeons are excellent at Liposuction so provider selection is absolutely paramount.
To answer your question, you can definitely have multiple injections of smaller doses of Kybella, 
Having to go through the recovery process multiple times seems highly undesirable in my opinion.
Why would you want to spend two weeks looking like a bullfrog more than is necessary. Even conservative doses will leave you visibly swollen. 
The recommended treatment is recommended for a reason.
I suggest you go with providers who use standard injection techniques.
Alargan spent significant effort in clinical trials, getting the injection technique as good as possible.
Rely on others having done this before you to figure out how it’s done correctly, if you insist on having chemical fat destruction with the injection of Kybella. (Again I’m not a fan of this treatment) I’m sorry if my response comes across as being negative.
I’ve been doing this too long to be enthusiastic about the treatment.
As a final adjuvant in the support of Kybelka the treatment using conservative dosing is safe and has a small chance of horrific outcomes. This is probably the best argument for conservative treatment with a technique which is often underwhelming in the first place. Both liposuction and Kybella can leave people permanently disfigured.
Liposuction is a more effective and better treatment. It also has a greater chance of disfigurement because of its effectiveness. provider selection is probably slightly more important when choosing Liposuction because of its definitive nature.
Anytime, excessive amount of subcutaneous fat is removed regardless of treatment method. The patient can be permanently disfigured and correcting this is virtually impossible.
There is also the issue with facial nerve paralysis. This is real and happens more frequently than most people realize. The paralysis is typically temporary but the complication can be pretty devastating. It can also happen from liposuction but is avoided if the treatment are done to avoid where the nerve becomes superficial as it crosses the mandible. This is typically in the jowl area. The jowls should not be treated if you want to minimize facial nerve injury. 
In the end provider selection is usually the most important variable, regardless of what treatment is chosen.
Finding the right provider is often far more difficult than most people realize.
Best,
Mats Hagstrom MD

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