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INJECT, FREEZE OR BOTH? BANISH CHIN FAT FOR GOOD!

Just three months ago we talked to Stamford, Conn., dermatologist Omar Ibrahimi about Kybella, an injectable zapping chin fat approved by the U.S. Food and Drug Administration in April, and already another option is hitting doctor’s offices to do away with double chins. Zeltiq Aesthetics, the company behind CoolSculpting, a non-surgical procedure that destroys fat by freezing it, has introduced an applicator called the CoolSculpting Mini to target small pockets of fat, including the ones that intractably cling to your craw. If you’re confused by the surplus of choices, you’re not alone. It’s great that there’s a growing repertoire of fat-busting solutions for those of us who don’t want to go under the knife, but the pace of innovation puts iPhone updates to shame. To clear up any confusion, we called up Ibrahimi again, and he generously took the time to set the record straight on the duo of double chin busters.

Q: Why are these two options to decrease double chin fat being made available now?

A: It is definitely an area where there has been an unmet need in terms of what we can offer patients. The CoolSculpting Mini is another option that makes it possible to have a non-invasive or minimally-invasive procedure that can tighten the skin there to make you look younger and have a sharper jaw line. This procedure works in a completely different way. When we freeze fat at a specific temperature, we can kill the fat cells without harming the other cells in the body. It treats the fat under the neck with a controlled protocol in which the fat cells are frozen and die over two to three months.

Q: What are the differences you’ve when using Kybella versus the CoolSculpting Mini?

A: The nice thing about the CoolSculpting Mini procedure is that there are no needles, so bruising is much less likely. Swelling is more modest. I did this procedure, and I worked the next day. With Kybella, bruising is a little more common, and the swelling is a little more prominent. However, in my experience over the few months since I’ve had Kybella is it is one of the few things that works as well as the company touts it to work. I have been really impressed with the results with Kybella. With CoolSculpting, the clinical trial data looks exciting, but it is still a wait-and-see to see how reproducible it is on the mass market. The clinical trials for Kybella were very rigorous because it was FDA approved for a medication, whereas the CoolSculpting Mini is FDA cleared as a device, so it doesn’t have to meet the same rigorous clinical trial standards that Kybella had to.

Q: How do you guide a patient toward choosing one of these options versus the other?

A: In a busy aesthetic practice like the one I have, we have a need for both options. The patient that is coming in that is concerned about downtime and may be willing to have little less efficacy, I might end up going with the CoolSculpting Mini for them. The patient that wants something that has the strongest amount of evidence behind it, but they are not looking for anything surgical and they are willing to tolerate more downtime and swelling, those would be the people that would tend to go for Kybella. I foresee that I could mix and match both techniques, too. Maybe I would treat them to start with the CoolSculpting Mini and then, when they have more time for a little bit of downtime, I could go in with Kybella and get them results that way. There might also be patients that we could start off with with the CoolSculpting Mini and, as their fat gets localized, we could pick that last little bit off with Kybella. There is a role for a combination of treatments. In reality, I would recommend someone thinking about this to consider both options.

Q: How much do the procedures themselves vary?

A: The Kybella procedure just takes a few minutes of marking the area and, then, the actual injections only take a few minutes. You are in and out in 15 minutes. The procedure takes a little bit longer with the CoolSculpting Mini. You are probably here for about an hour. It feels like your body part is exposed to the cold. It is very minimal in terms of pain. I would describe it as discomfort rather than pain. Afterward, there can be a little bit of tenderness, but probably 90 percent-plus of the time it shouldn’t stop patients from going about the activities of daily life.

Q: Is one option better than the other for long-term results? 

A: The nice thing about Kybella is that we have a tremendous wealth of clinical data. The trials were larger and were going on for almost 10 years in duration. We have  a history to speak to its permanency. The mechanism by which the CoolSculpting Mini works is similar to other applicators. We know that fat can be killed by controlled cooling, and the results are generally long lasting. I do feel comfortable and confident telling my patients that this should be a lasting result.

Q: Is there a price difference?

A: Overall, costs would probably be similar. Both of them aren’t going to be single treatments, and you are done. They are both going to be a series of treatments. For Kybella, most patients are going to need somewhere from two to four treatments. With the CoolSculpting Mini, I would say if [their problem is] extremely mild, they might be lucky and get away with one treatment, but they often might need a second treatment and, if they have a pretty extensive double chin, they are definitely going to need more than one applicator treatment.

Q: Previously, you said your patients who received Kybella treatments were quite satisfied with the results. Are patients who chose the CoolSculpting Mini satisfied as well?

A: Our patient satisfaction is very high with CoolSculpting. At the time of consultation, we try to set realistic expectations. This is not a way to lose weight. This is not a way to become healthier. This is not going to give you a surgical result without surgery. It is really modest improvement in stubborn pockets of fat. My ideal candidates for CoolSculpting are patients close to their body weights that have stubborn pockets of fat because they are older or they have had a baby. No matter how much they are in the gym, they just can’t take care of those stubborn pockets of fat.

Q: Given how quickly it seems new procedures arrive at doctor’s offices, is it better for people with concerns about their double chins to wait to evaluate what’s coming down the pike or take the plunge now with Kybella or the CoolSculpting Mini?

A: There are going to be other alternatives coming down the line, some of them are going to be other molecules [like Kybella] that can be injected to kill fat. Other sources of energy are also going to be looked at. Even though it was FDA approved in April and is new to the U.S., Kybella is something that we have a lot of experience with, and we know it works really well. I think it is going to be hard to beat the results that one can get with Kybella with some of the other things that might be in development. If it [chin fat] is something that bothers you, you should feel comfortable getting a consultation with your board certified physician, dermatologist or plastic surgeon and discussing the treatment options. I do not think there is going to be anything radically better in the next few years.

 

 

 

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