Treatment Options for Double Chins

Excess fat under the chin, often called “double chins” is a very common cosmetic concern. Double chins don’t always respond well to diet and exercise, and there are genetic factors involved, and aging can also play a role. This transcript is from cosmetic dermatologist Dr. Shannon Humphrey, explaining double chins, and some new options to improve double chins without a major surgical procedure.

What is Double Chin?



The term “double chin” refers to fullness under the chin. In the medical community, it’s called submental fullness. In most patients, one of the primary components of submental fullness is fat. For different reasons, either due to weight gain, genetics, or aging, patients can end up with more fat under the chin than they’d like. There’s other structures there like muscle, and then there’s skin, and those things can contribute as well to the appearance of fullness. Most patients don’t like having fullness under the chin, and that’s because a prominent and well defined chin and jawline plus definition under the chin is a feature of beauty and attractiveness, both in men and women.


What treatments are available for double-chin?



Treatments for submental fullness or double chin, really target the fat to remove the bulk, and to also smooth the contour under the chin. Some options that we have available to us that are minimally invasive include an injectable treatment that’s called Belkyra, or Kybella. It uses a bile salt to dissolve fat that the immune system, then clears away. Another option is an energy based treatment called the CoolMini. It uses cold temperatures to freeze fat, and again, the body sends in its scavengers that are part of the immune system to clear away those frozen fat cells. Finally, for patients who have a larger collection of fat under the chin or who are looking for a complete correction—those patients may consider a surgical intervention like liposuction or another plastic surgery intervention to re-contour the submental region.


What is Kybella and how does it work?



Sodium dioxycholate is the active ingredient in a new injectable treatment called Kybella in the United States, or Belkyra in Canada. Sodium dioxycholate is actually a bile salt, so it’s actually a naturally occurring molecule that our body uses to digest and absorb fat when we eat it. Someone really smart decided that we would inject this into areas of unwanted fat in the body, specifically under the chin and see what happens. So over a rigorous series of studies, we’ve seen that the fat is in fact, cleared away by the immune system and in many patients, there’s an improvement in the contour. For many patients, the skin actually tightens up, so not only do we see a reduction in bulk, but we see an improvement in definition among the jawline, and also contouring under the chin. This is a treatment that’s done in the office. It’s a relatively quick and comfortable procedure, and patients can see improvements in the contouring under the chin, over a series of treatments, anywhere between 2-4 treatments. One of the first questions that patients usually ask me is “well, how long does it last?” This is a unique treatment, in that once we have the result that we’re looking for, we don’t expect that these patients will need retreatment. We expect that it will be long lasting if not permanent.


Who would be a good candidate for Kybella Treatment?



A good candidate for Kybella, is a patient who has a localized collection of fat under the chin and skin that has good elasticity—so skin that is well opposed to the bulge of fat. Those patients are very likely to have a very predictable improvement. Some patients who may not be ideal candidates are patients who have fullness under the chin for other reasons—they may have larger submendibular glands that cause a bulky look, they may have bands of muscle that pull down—those patients wouldn’t be expected to respond to Kybella. Another patient who may not choose that treatment would be a patient who has significant skin laxity. If the skin is very saggy under the chin, it may not snap up to show a desirable contour when you dissolve the fat away.


What are potential Side-effects of Kybella Treatment?



Kybella has been studied extensively. In the phase III trials we got some really clear information about what side-effects patients should expect.

  • There’s some mild discomfort when the medication is injected. A burning discomfort that can be experienced for 5 to 15 minutes after the injection.
  • Many patients choose to have injectable lidocaine because this makes the area under the chin numb so they won’t feel the discomfort.
  • There is swelling associated with the Kybella treatment, and it varies between patients. For some, it’s not much at all, but for others, it can be quite significant.
  • The swelling lasts for a median of 11 days. This means that half the patients have swelling that’s gone before 11 days, but for half of patients, they would expect that swelling to last for 11 days and beyond.
  • It’s important to consider your professional obligations, your social obligations, to time your Kybella or Belkyra treatment.
  • Many patients experience numbness in the skin overlying the chin area that can last for several weeks
  • One of the reassuring things about the treatment and what we saw in the phase III clinical trials is that the vast majority of side-effects are mild and they resolve over time.

What is the cost of Kybella treatment?



Kybella in the U.S. and Belkyra in Canada will be priced individually between different physician’s offices, and also between patients because different patients will have different amounts of fullness and would require different sizes of treatment. It’s really something that you will need to discuss with your individual physician, but in most cases the price for this treatment would start at $1000 and increase from there depending on the treatment plan.

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