The ideal patient is someone with mild to moderate submental fullness, or double chin, but not a very heavy or full neck, he said. Patients will typically be 30 to 50 years old; the treatment for those who are older than that is usually too extensive for Kybella, although there are exceptions, Dr. Williams said. A grid is placed over the treatment area that marks where the injections are to go, so the procedure is not technically difficult, he added.
Explore this issue:September 2015
Carlos Wolf, MD, a facial plastic surgeon with Miami Plastic Surgery in Florida, said he was skeptical of the treatment as well, but after a recent training session, he now thinks it has a place in treating carefully selected patients—generally those in their 20s to 50s with good skin elasticity. One consideration is that patients need to wait a month between injections for the effects to be seen. “They’re not going to get instant gratification; it’s going to take them one, two, three, or four months to get where they want to be,” he said.
As for safety, “The reality is that the area that they’re talking about is really a very specific area bordered by fairly safe territory,” he added.
The price is fairly high, he said, but he thinks it’s possible the company might have to make some adjustments after the treatment gains some traction. He said his practice hasn’t settled on pricing, but one possibility is that practices will offer a global price, with the cost of each treatment falling below that amount and some above it.
Dr. Spiegel said he wonders about the drug’s potential uses beyond double chin treatment. “Just like botulinum toxin came out with one indication [and] has now expanded to many, many uses, I think the creative minds of facial plastic surgeons will start thinking about ways to use this new tool,” he said.
Dr. Williams said he thinks Kybella will be “expanded upon in other areas.” Dr. Wolf said he can already think of several ways the treatment might be used off label. But those other uses might be slow to emerge. In announcing its approval, the FDA cautioned that Kybella is only approved for under-the-chin fat treatment and that “it is not known if Kybella is safe or effective for treatment outside of this area.”
Thomas Collins is a freelance medical journalist based in Florida.