hi i'm dr johnny thanks for joining me
today we're talking
kybella there are a lot of questions on
can you use it on the face
can you use it on the jowl what's the
dose
it's belkira in canada a lot of
europeans on here
i love learning people send me all
different formulations
and they're saying a lot of diys do it
yourself people
they send me the name of their what
they're using a lot of korean stuff i
look it up some of it has uh additives
such as carnitine which is a skin
tightener
collagenases and different things
there's all kinds of cocktails
especially in europe
we're going to cover a plethora of
things today
about fat dissolving we talk about the
korean v-line
slimming should it be used for that some
of the pitfalls
do you need to use the grid there's a
lot of stuff on kybella
and we're going to look at the before
and after picture talk a little bit
about expectations
should you do it have you did it we're
gonna dive in
three seconds
[Music]
okay kybella is sought after
it's a little bit expensive in the
united states there are other versions
a lot of people talk about compound
aversions or what are they using in lipo
dissolved cocktails
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now if we talk about uh
belcher in canada kybella here kythera
pharmac pharmaceuticals
started to make it commercially
available as
kybella it was bought by allergan now
owned by abbvie
and it comes in vials about 2.2 ml
it's d oxycolic acid a bile salt
a secondary bile salt now what it does
it disrupts the cell membrane of the fat
it
once you open that biphospholipid
membrane
it kills the fat cell so it is permanent
people say well
what's permanent and why is it permanent
understand
in effect nothing's permanent but those
fat cells that are gone
are gone for good why are permanent
things
such as the korean bee line such as
facelifts which people think are
permanent such as permanent fillers
why are they not permanent think nothing
lasts forever because the face
continues to age the bone changes the
fat changes
there is some hypertrophy and atrophy so
the fat grows
and it slims we know that to be true
that's how facial aging occurs
and body aging collagen and elastin a
facial implant when you put it in
yes that's a permanent event but
say you get it in a 50 at 70 you might
see the outline of that implant
which is why an implant if you want a
permanent implant something like bella
fill as a filler is better or better yet
something you can dissolve and change
hyaluronic acid
so when you say permanent for kybella
yes it permanently reduces the fat cells
and as a benefit you only have so many
fat cells what do they do they expand
they contract for a living they expand
when we gain weight
sometimes as we age and they shrink
likewise
okay so what the fat cells that are gone
are gone for good
there are less to shrink and expand we
now know that
now when you say we get rid of fat
there's also fat around nerves in the
form of
myelin so the electrical impulse travels
it hops along this nerve sheet that
means that you can get nerve damage from
it
why am i bringing it up because a lot of
people want the jowl
fixed and i have a whole video dissolve
your gels raise
pedial threads a little bit of filler
but also kybella here
i've done it for years yes i've had a
couple patients that drooped their smile
for about one to four weeks
four weeks max they all come back why
the myelin the fat around the nerve cell
comes back
it regenerates so this isn't a permanent
event
however when we're talking buccal fat
for bee line slimming that's another
deal because
there are different nerves different
depths
and put your tongue in there your mouth
is awful close
and guess what's there your parata gland
and your parotid duct
most importantly so be very careful but
it can work well so one of the uses is
facial slimming so the marginal
mandibular nerve comes up
where right where you don't want it to
where the pre
jowl is and where we want to get rid of
it that's why in the study
which had about sixteen hundred people
uh there was a three to four percent
smile change from that nerve being
affected
but they all came back now the grid
let's talk about the grid
when you have something fda approved of
which
the other products are not so the
compound aversions
are not fda approved they're off label
use for the under chin and they aren't
the exact same formulation
as kybella they are different
concentrations and
often mixtures of pcdc
phosphatidylcholine and deoxycolate
the purest a lot of mesotherapists
especially in europe because
that's where it really was popularized
believe that you need
phosphatidylcholine n-deoxycolate
combined to one to disrupt the cell
the other to go in and kill the cell so
that combination you'll see
normally used often used with vitamins
minerals
lidocaines different things for
different reasons
dispersants to help disperse the product
and keep it smooth
those are the the kind of lipo dissolved
cocktails
the korean cocktails or asian cocktails
and
nothing bad about them they can work as
well or better
there's different laws and the ability
to use different products more freely
sometimes in other countries not all the
time you'd be surprised
some of the things that do not get
approved so
if you think about the grid yes the grid
was there so it could be studied and fda
approved
in the united states and canada so they
had to standardize it
we go off the grid regularly rarely the
people use the grid anymore
they talked about getting modified grids
so that include the pre-jowl and so on
waste the time if people do this for a
living and their aesthetic providers
they know where the nerve is and they
know they should know where not to go
and if you want the pre-jowl it works
really well
takes a few treatments you have to know
that that's the expected side effect
that you could get that
that droop or that that that when you
smile
one side doesn't lift as much so in
effect a droop
only seen usually on big smile that's
the good thing about it
so there we have a side effect from it
now
you do get swelling and you need
multiple treatments things that people
don't like
but each time you get it get less pain
less swelling
less downtime and it works better
because there's what
less fat cells to disrupt cause pain
so you need several sessions and it can
make it expensive
and a lot of people can't deal with the
swelling
when's a good time to have a turkey neck
for
how long typically to other people
about three to seven days in studies
to the patient which is sometimes more
important
usually for two weeks because the
patient sees it it doesn't matter that
no one else does
they're bothered by it they're calling
your clinic unhappy
now why wouldn't you go get lightbulb
lipo if you have a large neck and i've
seen large necks
people don't want surgery for whatever
reason look like surgical results
but it's not that predictable in general
kybella is not that predictable and in
general
you're going to have two to five vials
per session
and that borrowed true in the study
that's what people got they'll tell you
three sessions
but in general think to get those
results
three to five biles a kit is four
so you can expect to pay anywhere around
eight hundred dollars roughly i would
think a kit
um three sessions you're at twenty four
hundred dollars
pretty easily okay now you avoid surgery
and you can get it done in the office
there's something to that
because you walk in for your neural
modulator boom boom you get that
maybe a little filler a couple
injections you get a bit of pain and
swelling
you don't have to go into the knife no
anesthesia there's a benefit there
for many people an opening here and i do
see it scar once in a while
and if people look from underneath you
can see there's a telltale sign
if people get keloids or scars it's not
great but
in general liposuction for some is what
they want because they're in and out
roughly going to be the same price now
skin tightening does occur with kybella
we see it
well why don't we tighten the lower neck
it'll get rid of
wanted fat we want fat down here we
don't want it under here
so when you get rid of fat here it makes
the neck look older
so i do do it in select cases when
there's a lot of fat here
tightens well liposuction and the lasers
don't add much to laser liposuction
they just don't do a lot so you can end
up with loose skin
after surgery and a lot of people end up
getting a platysmaplasty or
a necklift because there's just too much
loose skin
after the fat's gone so if we look here
at this before and after
this is three treatment sessions think
anywhere around nine vials and you can
price that out with your provider
whatever country you're in
so you have to be willing to go through
it i'm a fan
i like it i use it in the pre-gel i use
it
on the face i use it on the body we've
used i've used lightbow dissolve since
2004 so i like it it works really well
i'm very comfortable with it
coolsculpting a lot of people might
choose to freeze it which is good you
can do a combination
likely you're going to want some kybella
after cool something
to fine-tune it but roughly it's going
to be around the same price
because when you add your coolsculpting
cryolypolysis to it
you get there so that's kybella there
you go a little bit of an
update of what it is how i use it some
of the pitfalls
have you had it do you like it let me
know
keep your skin and body beautiful
healthy and vibrant
thanks for joining me