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A Brief History of the Breakthrough
Drs. Rotunda and Kolodney investigate deoxycholic acid
(before it was Kybella™) in 2003.
"This study is going to define your career, " Michael S. Kolodney, M.D., PhD., then Assistant Professor of Dermatology, remarked to Adam M. Rotunda, M.D., as he worked with the UCLA dermatology resident in his lab. Dr. Rotunda didn't realize how prophetic his mentor's insight was at the time.
In 2001, Patricia Rittes, M.D. treated excessive eyelid fat with a combination of medications that appeared to reduce fat without surgery. Soon after, Glynis Ablon, M.D., Assistant Clinical Professor at UCLA, invited the then first-year dermatology resident, Dr. Rotunda, to co-author a research paper that described the same fat-reducing effect from a medication similar to that used by Dr. Rittes. While these findings were very exciting, they stirred some controversy since no one quite understood how the medications worked or whether they were very safe.
To further explore the medication, in 2003, Drs. Kolodney and Rotunda performed a series of simple but surprisingly revealing experiments that showed that an esoteric substance within the medication – deoxycholic acid – had very powerful effects on fat. These laboratory studies revealed that deoxycholic acid disrupted fat cells, completely eliminating and reducing fatty tissue while leaving surrounding tissue relatively unharmed. The potential applications were groundbreaking – but more studies were needed to confirm their results.
Dr. Rotunda and Dr. Kolodney published another study investigating that deoxycholic acid reduced and destroyed lipomas, disturbing but benign fatty tumors. This study was particularly important because it offered clinical meaning to their laboratory discoveries. Dr. Rotunda and his colleagues then proved that deoxycholic acid reduced submental (under the chin) fat, which could otherwise only be eliminated with liposuction. These studies motivated the start-up biotech company, Kythera Biopharmaceuticals, to license the drug from UCLA/LA Biomed and begin rigorous investigations of the drug's use as a non-surgical treatment for fat.
While the path to FDA approval is expensive, long and filled with many roadblocks, the company developed a team of people focused on success. After a decade of treating over 2600 patients in 11 clinical trials, deoxycholic acid was finally approved by the FDA as a treatment of moderate to severe submental (below the chin) fullness on April 29, 2015 under the name Kybella™.
Throughout the decade of research, Dr. Rotunda authored numerous peer-reviewed, original scientific articles about deoxycholic acid (see them here), contributed to numerous book chapters, wrote commentaries about his colleagues' work on the subject, and travelled the nation and world lecturing at physician conferences to discuss his research and discovery.
Throughout this journey and manifest in his life today, Dr. Rotunda has seen the powerful and positive effects of mentorship, hard work, curiosity, creativity, gratitude, persistence and working with phenomenally talented people.
Questions & Answers
Why does Dr. Rotunda use Kybella™ in his practice?
Dr. Rotunda co-invented the use of the main active ingredient in Kybella™ – deoxycholic acid – for fat removal over 10 years ago, while he was a dermatology resident at UCLA. Read more about this story in the History section above.
After completing his dermatology residency training, Dr. Rotunda became a fellowship trained Mohs skin cancer and reconstructive surgeon. Read more about Dr. Rotunda. His private practice and teaching appointments have been devoted exclusively to skin cancer treatment.
However, Dr. Rotunda continued to research, contribute to and teach about injectable fat loss treatments over the past decade as the pharmaceutical company, Kythera Biopharmaceuticals (acquired by Allergan in September 2015) developed his discovery.
Dr. Rotunda therefore has a very unique knowledge about and experience with deoxycholic acid – he was there from the beginning (quite literally) and now is humbled to see it available to potentially benefit millions of patients. He is honored to be able to offer it in his practice.
Why is Kybella™ treatment receiving so much attention?
Prior to Kybella™ , previous treatments for submental fullness (neck fat or "double chin") were limited to liposuction, a surgical procedure to remove excess fat. Submental fullness results from genetics (look at your parents!), aging and weight gain, and about 70% of men and women are bothered by it to some degree, affecting their confidence and self-esteem.
While liposuction is effective, patients are not generally enthusiastic about surgery. After receiving a sequence of Kybella™ treatments, patients can see a significant reduction of their neck fat – without cutting, without sucking fat away, without surgery! Kybella™ therefore represents a completely new class of treatment that promises to be as effective at reducing volume as fillers (such as Juvederm® or Voluma®) are at adding adding volume.
What exactly is Kybella™ and how does it work?
Kybella™ is a prescription medicine approved for the reduction of moderate to severe fat below the chin. Its active ingredient, deoxycholic acid, breaks down fat cells permanently. Deoxycholic acid occurs naturally in our bodies to aid in the digestion of dietary fat in our intestines. A synthetic, highly purified version of this natural chemical found in our bodies is used in Kybella™. Figures of how deoxycholic acid works courtesy of Kythera Biopharmaceuticals:
Before injection, fat plump and happy
Kybella™ disintegrates fat
Fat cells removed by body
What happens to the dissolved fat?
Studies show that after treatment, fat is slowly removed from the treated area through the bloodstream. In those studies, cholesterol, triglyceride, and free fatty acid levels (all measure of fat in your blood) increased after the injection no more than what would occur after a meal. Kybella™ will not make medical conditions like high cholesterol or high triglyceride levels worsen. As well, the removed fat will not be deposited somewhere else.
What type of patient will get the best results?
Adults with firm (not loose or hanging) skin and excess fat below the chin and on the neck that can be pinched with their fingers are typically very ideal candidates. Because this product will not help saggy skin, patients with very lax or loose skin may not be good candidates.
Ideal candidates are also patients who are patient! Kybella™ works over many months, so patients who desire to lose the fat immediately are not ideal candidates and may want to consider liposuction instead. However, while liposuction's effects are relatively immediate, the rapid changes may be obvious to others, causing the patient to feel self-conscious.
Kybella™ on the other hand, creates the illusion to others that weight is being lost gradually, allowing for a more natural and therefore less obvious change.
Do I need a consult before my first treatment?
Not every person who desires Kybella™ is an ideal candidate for the treatment. We recommend a quick consult prior to your potential treatment to ensure you will achieve success with Kybella™. At that time, however, you may be treated if you are willing and able to do so.
Are men also candidates?
Absolutely. In fact, many men hesitant to enhance their appearance with Botox® and fillers are very willing to reduce their neck fat with Kybella™ With a more chiseled profile, men appear healthier, younger and less overweight. And because the effects appear gradually (over months), it is not obvious to others that "work was done."
What is the treatment like?
Your neck and chin area will be marked with a pen and then a mixture of anesthetics will be injected to ensure comfort during and soon after the procedure. A marking template will then be applied and Kybella™ will be injected with a very thin needle into the fat layer below the skin. You may be in the treatment room for 15-30 minutes but the injection part of the procedure takes only about 5 minutes. Such a short time for such a lasting benefit!
How many treatments are needed?
Most patients require 2-4 treatments, spaced 4-6 weeks apart. Occasionally, patients with a larger amount of fat will need 5 or more treatments.
What happens to my neck skin as I lose the neck fat?
For most patients, the skin remains just as tight as before treatment. This is because deoxycholic acid produces tightening effects in the skin as the injected area heals. Some patients with pre-existing loose skin may have increased wrinkling or more obvious banding ("platysmal bands") of their neck. There are additional cosmetic treatments to reduce neck wrinkling and platysmal bands.
Are results permanent?
Yes! However, weight gain or increasing skin laxity with age might cause double chins to recur.
What are alternative treatments for submental fullness?
Liposuction is the only truly effective and accepted alternative treatment.
Will I need other treatments as well to make my chin and neck look their best?
Lax, saggy skin or jowls can be improved with some energy based devices and fillers. Botulinum toxin (Botox®) can reduce prominent vertical neck bands (platysmal bands),which may appear to look more prominent after Kybella™ treatments since they become "unmasked" when the fat no longer hides them.
What are the side effects?
Most of the side effects are a result of the disruption of the fat by deoxycholic acid – that's just how it works! The fat cell disruption is really a controlled injury, so like any other injury, you will be tender and swollen. A majority of patients have swelling and/or bruising for several days to up to a week, and patients concerned about this may wish to begin treatment close to a weekend. However, the more Kybella™ used in the treatment session, the more likely the swelling will last longer than a week. Many patients have skin redness and tenderness to the touch, and numbness may occur as well, which may last for several weeks (this usually is not bothersome and it actually may make the next treatment more comfortable).
Fortunately, most of these side effects lessen on subsequent treatments, sometimes substantially. Rare side effects include: difficulty swallowing during the first few days (this is thought to be due to the neck swelling, not harm to the throat); nerve damage causing an uneven smile or facial muscle weakness (very rare); skin darkening above the areas injected; and for men, some loss of beard hair. Fortunately, all of these side effects are transient, or short lived.
How should I prepare for my treatment?
- To reduce the risk of bruising and swelling, avoid aspirin, ibuprofen (Advil®), vitamin E, fish oil and similar medications for 1-2 weeks before your treatment. You may also wish to reduce drinking alcohol for several days prior to the treatment.
- To help reduce bruising and swelling, you may also want to use Arnica Montana starting the morning of your treatment or immediately after.
- Men should shave their neck and beneath the chin the morning of their treatment.
- If you can take ibuprofen (Advil®) or acetaminophen (Tylenol®) - consult your primary care doctor if you do not know whether you can or not do so - please take 400 mg ibuprofen (2 Advil® tablets) and 1 Extra-strength Tylenol® (500 mg) with food 1 hour before your treatment to reduce immediate swelling and discomfort after treatment (this will not affect your risk of bruising).
What do I need to do after my treatment?
No special care is needed afterwards except perhaps icing the area for the rest of the treatment day to relieve tenderness. Women may wear a scarf to hide the swelling or makeup to hide the bruising.
Does Dr. Rotunda perform other cosmetic procedures?
No, Dr. Rotunda's practice is limited to Kybella™ treatments and the treatment of very serious skin cancers. He is a board certified dermatologist and a fellowship trained Mohs and reconstructive skin surgeon. Kybella™ and Mohs surgery are his areas of expertise. Should you need or want other cosmetic treatments, he can refer you to a trusted colleague.
Before & After
Photographs are representative of ideal Kybella™ patients. Results may vary from patient to patient.
5 treatments total, 3 vials per treatment
3 treatments total, 3 vials per treatment
4 treatments total, 2 vials per treatment
5 treatments total, 3 vials per treatment
6 treatments total, 2 vials per treatment
4 treatments total, 3 vials per treatment
Videos & Media
Please call (949) 336-7171 if you have any additional questions or if you would like to make an consultation for Kybella™ treatment. Thank you so much.