Q: Dr. Eppley, I have been researching Kybella treatment for my moderate jowl laxiity. I consulted with a plastic surgeon and he rejected me suggesting that I lose weight. I am 53 years old, 5’6″ and weigh 150 lbs. I averaged 127lbs through my 40’s to the present. I have great confidence in my dermatologist and she has recommended two treatments of Kybella,and has told me there is a 4% chance of a temporary drooping of the mouth. Most of my research says that Kybella is not recommended for the jowls. I am writing to you because you are the first I’ve come across to suggest that it can be effective for that area. Could you tell me with your experience to this date, if you still think it can be relatively safe and effective in smoothing a mild/moderate jowl sag? Many thanks in advance for your response.

A: The concept of injection lipolysis (Kybella is the one brand name for now) can be done anywhere there is fat. It is not a question of whether it can be done but whether it will be effective and has a low risk of problems in doing so. Thus the jowls can be injected and some mild improvement may be capable of being achieved. It will not be as effective as small cannula liposuction or even a small jowl tucked however. The risk of injecting the jowls is injury to the marginal mandibular branch of the facial nerve. Such injury will not cause month drooping but rather will cause lower lip elevation and smile asymmetry. Such an injury can occur from the intense inflammatory reaction that the injected deoxycholic acid solution causes. Such a reaction occurs in a 1 cm zone around each injection site. As long as one stays well away from the marionette line area of the chin this complication can be avoided. I have never seen it occur in the patients I have injected.

Dr. Barry Eppley
Indianapolis, Indiana