Belkyra is a new novel way of dissolving double chins. The active ingredient is an acid which has been well established to breakdown fat. Belkyra is also known as Kybella in the United States. This treatment has been around for over four years and has been approved by the TGA, FDA and CE or European medical clearance organisations. It can thus be said that with extensive investigations and trials, Belkyra is both safe and effective.
The question then arises, why do I prefer CoolMini versus fat dissolving injections that have been approved by the TGA?
Submental fat or double chin treatment is one of the most requested treatments. With age we lose our support for the chin area, our collagen and muscles which support the area loosen over time and fat accumulates with both weight and age. This leads to the dreaded double chin and the “lets look up selphie”. To treat double chins, there are essentially only several proven methods. Firstly one can cool fat using a device know as Coolsculpting. Using a special applicator, this has been proven to be extremely effective in over 90% of patients. The second method is to heat fat. There are certain devices out there which can heat fat and destroy the fat cells permanently. Another reliable method is liposuction. However, this is an invasive method which has a longer downtime and carries surgical risks. The last method is to use fat dissolving injections using the deoxycholic acid.
My preferred way of treating the submental fat area or double chin is to actually use CoolMini. Here are my five reasons why I prefer Coolsculpting CoolMini versus Belkyra injections for double chins.
The CoolMini is associated with minimal downtime and swelling. Bruising may occur in 25% of patients; however, this can be covered up and short lived. Swelling is minimal compared with Belkyra injections. With Belkyra the company often downplays the amount of swelling. Swelling is universal with fat dissolving injections. The bottom line is that the more fat you have the greater the swelling. In this industry we call this the ‘bull frog effect.’ 100% of patients who receive these injections will have significant swelling which last approximately 5 to 10 days. If you can fit in the CoolMini Coolsculpting applicator, my suggestion is consider Coolmini before Belkyra. To assess if you are a candidate for CoolSculpting Coolmini click here.
- Side effects
With CoolMini side effects are minimal. Apart from transient bruising and swelling, Coolsculpting in this area is extremely safe. With fat dissolving injections, there is a risk of not only swelling, bruising and downtime but also partial nerve damage. The injections themselves are easy to perform as we use the template. In fact, it is so easy that the procedure is over in 60 seconds. The downside, however, is that in 5% to 10% of patients a branch of the facial nerve which innovates the muscles of facial expression runs below or at the level of the injection site. The fat dissolving injections demyelinate the nerve sheath which contains fat. This can result in temporary paralysis of the muscles that are innovated by the facial nerve. This leads to an uneven look; however, rest assure that this is temporary. In the vast majority of cases, the nerve regenerates within a period of 6 to 12 weeks. This side effect is under reported. Once again those in the industry know that this side effect occurs between 3% to 5% of all patients injected. In my opinion 1:20 is a very high risk and hence I try to avoid using fat resolving injections as my primary modality for the treatment of double chins.
The cost of fat dissolving injections are astronomical. This is due to the fact that Allergan has placed the premium on there product. This has to be passed on to the patient. If we are looking at debulking a moderate area of submental fat, often up to four vials are needed. In comparison, Coolsculpting will only take between one to two treatments. The bottom line is that the dollar saving is three times less with Coolsculpting compared with Belkyra.
With Coolsculpting Mini, pain is not felt. A cold sensation is initially felt the first few minutes, thereafter, the area is numb. The pain is minimal compared with fat dissolving injections using the Kybella. We have, however, found out that the use of local anaesthetic in a tumescent method prior to the injections of Belkyra/Kybella can alleviate pain to the point whereby it is not a problem. Pain following Kybella is often described as burning; however, once again, this is short-lived. The use of paracetamol or Panadeine after the injections is all that is needed to alleviate the pain.
I rate both CoolMini/Coolsculpting and Kybella as predictable procedures. Patient selection, however, is critical. In this situation, I do believe that the CoolMini has an advantage. The reason being is that if you can fit into the applicator, then chances are that your CoolMini treatment to your double chin will be extremely successful. What this means is that the applicator size itself preselects the patient. In some patients where the CoolMini does not fit as well, I used another applicator called the CoolTech Mini. In this situation, we have two applicator sizing to fit different size chins. In context of Belkyra, once again patient selection is critical. I do what is known as the pinch test to see how much submental fat there is. Additionally, I palpate to find the cricoid cartilage. If your cartilage is placed more posterior, ie, to back of your neck area then the results from Kybella/Belkyra will be better than if the cartilage is placed more forward. Essentially if the cartilage is to the back, the angle is sharper and hence the perceived treatment is better.
Does this means I am against Belkyra injections?
Absolutely not. I do believe that there is a role for these injections and that they are extremely effective in the right hands. My methodology of reducing double chins is to first of all debulk the majority of fat using Coolsculpting. I then reassess the anatomy. I place the majority of my injections posteriorly, namely as far back as possible from the mandible to avoid hitting the facial nerve. In this way it provides patients with huge cost saving, minimal downtime, less side effects and most importantly a good result due to the fact that I finesse the area. This limits the amount of swelling due to the fact that the majority of fat has already been taken out by the Coolsculpting procedure.
How do I know if CoolMini is the treatment for me?
Assessment is the key to success. My viewpoint is that patients should always be assessed by my Coolsculpting team at the Fiori Institute of Skin and Body. If you do indeed have significant submental or double chin fat and if you can fit in an applicator, then I would always put this treatment ahead of Belkyra. Once you receive a good treatment with CoolMini, the team will refer you back to myself to finesse the area if needed. I found that the majority of patients are actually extremely happy with the CoolMini procedure and I often do not need to perform Belkyra injections.
Once again to make things crystal clear, there is a time and place for these injections. This includes patients who do not fit in the CoolMini or CoolTech applicator and for those patients who want the final finesse in nonsurgical removal of submental fat.
To assess what is the best method for non-surgical fat reduction book in for a free consultation book in with the team at the Fiori Institute of Skin and Body.