Kybella

So with that we are going to have Kendall lower her hand and as you can see, we have marked the typical dots that we want to use. We like to have the most concentration in the center part of the chin. The other thing is my assistant is going to be handing me the syringes so that I don’t lose my place. I think it is important to pinch the skin and go all the way down follow the grid, I usually stick inside the actual spot that the grid makes but rather I tend to go alongside of it. The grid is meant to be a spot where you know that you haven’t missed anything. Because ideally you want to have these injections about a centimeter apart and especially when you are near the jawline, you really want to pinch and pull it forward like that. It is great to have your assistant hand you the syringes because then you don’t miss your spot. I usually don’t go beyond the sternal plidomastoid in that area. And now we are going to go more centrally. Over here. The strips are anywhere from 0.1 to 0.2 ccs preferably 0.2. And you just want to course it along. Notice I am not going inside the tattoo. We don’t want to tattoo the patient. I always tell patients that they are going to need anywhere from 2 – 3 sessions depending on the severity, it takes a good six weeks to get the full effect. And again when you are near the jawline, you really want to pull it out so that you don’t hit the nerve. There is a technique where you can put it in the jowls for people who have severe jowling. But you do have to remember that the increased risk for marginal mandibular palsy is there. Now, Kendall what’s the maximum pain level you would give this and you can be honest. I would say maybe a 4 or 5. That’s good. Now the final thing that I do when I am done is I do a manual massage and what I use is an anti-bruise gel but the purpose of this is that the lymphatics which drain the fat and remember deoxycolic acid works by releasing the liposides. Deoxycolic acid emulsifies the fat and the cells actually rupture so the fat reduction is permanent. The lymphatics drain the fat away. The lymphatics are on the side of the neck. So I do this massage. And then last but not least, I tell the patient to do this massage as well when they are home. I think that it helps. As far as anesthesia, all we did is we used ice. In my experience, topical anesthetic does not make any difference. The reason is it is not the needle stick that causes the discomfort. The discomfort is caused by the burning as the cells are being lysed.