What is the proper technique for injecting Kybella (deoxycholic acid)?

Kybella Injection Technique

Inject Kybella (deoxycholic acid) at 0.2 mL per site using a 30-gauge or smaller 0.5-inch needle into pre-platysmal subcutaneous fat at approximately mid-depth of the fat layer, with injections spaced 1 cm apart in a grid pattern, avoiding areas within 1-1.5 cm below the mandibular border to prevent marginal mandibular nerve injury. 1

Pre-Injection Preparation

Patient Selection and Assessment:

• Palpate the submental area before each treatment to confirm sufficient subcutaneous fat between the dermis and platysma (pre-platysmal fat) 1
• Exclude patients with infection at injection sites (absolute contraindication), excessive skin laxity, prominent platysmal bands, or current/prior dysphagia 1
• Use caution in patients with prior submental surgery or aesthetic treatments, as scar tissue may alter anatomy and safety 1

Medication Preparation:

• Visually inspect vials for particulate matter or discoloration; discard if present 1
• Using a large bore needle, draw 1 mL of Kybella into a sterile 1 mL syringe 1
• Expel all air bubbles from the syringe barrel 1
• Consider topical anesthesia, injectable local anesthesia (e.g., lidocaine), or ice/cold packs for patient comfort 1

Injection Site Mapping

Critical Anatomical Boundaries:

• Do not inject above the inferior border of the mandible 1
• Avoid a 1-1.5 cm zone below the inferior mandibular border (from angle of mandible to mentum) to prevent marginal mandibular nerve injury 1
• Inject only within the defined submental fat treatment area between these boundaries 1

Grid Application:

• Outline the planned treatment area with a surgical pen 1
• Apply a 1 cm injection grid to mark injection sites 1
• Up to 50 injections may be administered per treatment session 1

Injection Technique

Needle Placement Protocol:

• Have the patient tense the platysma muscle 1
• Pinch/lift the submental fat to isolate pre-platysmal tissue 1
• Using a 30-gauge (or smaller) 0.5-inch needle, advance perpendicular to the skin 1
• Inject 0.2 mL of Kybella into the pre-platysmal fat at approximately mid-depth of the subcutaneous fat layer 1
• Do not withdraw the needle during injection, as this increases risk of intradermal exposure causing skin ulceration and necrosis 1

Critical Safety Points:

• If resistance is met during needle insertion (indicating contact with fascial or non-fat tissue), withdraw the needle to appropriate depth before injecting 1
• Avoid injecting into dermis (too superficial), post-platysmal fat (too deep), muscle, salivary glands, lymph nodes, arteries, or veins 1
• Injections that are too superficial may result in skin ulceration and necrosis 1

Post-Injection Care

• Apply pressure to each injection site as necessary to minimize bleeding 1
• An adhesive dressing may be applied 1
• Discard any remaining solution in the vial after use 1
• Dispose of needles immediately in a sharps container 2

Treatment Schedule and Expectations

• Administer up to 6 treatment sessions spaced at least 1 month apart 3
• Assess results 12 weeks after the last treatment session 3
• Most adverse events are mild to moderate, involve the treatment area, and resolve within approximately one treatment interval 3
• Common reactions include hematoma/bruising (72% of patients), pain, swelling, and induration 1

High-Risk Complications to Avoid

Marginal Mandibular Nerve Injury:

• Presents as asymmetric smile or facial muscle weakness 1
• Reported cases resolved spontaneously (range 1-298 days, median 44 days) 1
• Prevention requires strict adherence to the 1-1.5 cm safety zone below the mandibular border 1

Dysphagia:

• Occurs in setting of administration site reactions (pain, swelling, induration) 1
• Cases resolved spontaneously (range 1-81 days, median 3 days) 1
• Avoid use in patients with current or prior dysphagia history 1

Bleeding Complications:

• Use caution in patients on antiplatelet or anticoagulant therapy 1
• Excessive bleeding or bruising may occur in the treatment area 1