SEP 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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CHIN TO CHEST SOLUTIONS more downtime," says Dr. Shelton. "We usually prescribe a compression garment for two to three days and at night for a couple weeks." Patients who are bothered by prominent platysmal bands or dynamic wrinkles may not achieve satisfactory results with noninvasive RF or ultrasound devices. In these cases, botulinum toxin (BTX) may be useful, especially when used in conjunction with other treatments. "We use botulinum toxin on about 25 patients a day to relax the underlying musculature and enhance the benefi t of fi llers, lasers and other devices," says Dr. Kilmer. Topical BTX formulations—now being developed by Re- vance Therapeutics and Allergan subsidiary Anterios—may emerge as the latest innovation. But after more than seven years in development, there is still no estimate of when one of these products will reach the market. Tools for Reducing Fat The dreaded double chin affects all age groups. Until the 2015 FDA approval of Allergan's fat-dissolving Kybella (deoxycholic acid) injection and the CoolSculpting CoolMini (cryolipolysis) applicator from Zeltiq Aesthetics, liposuction was the only option for this problem. "Although liposuction is more invasive, results are excel- lent," says Dr. Shelton. "Kybella injections are minimally invasive. We use two to three vials per treatment and recommend three to six treatments, fi ve to six weeks apart," Dr. Shelton adds. "We always warn patients to expect the 'Jello jiggle' two to three weeks after treatment." The "Jello jiggle" is a sensation that makes patients feel like excess swelling or skin is jiggling or swinging around. One RealSelf reviewer describes it as having a "giant, pronounced bullfrog jiggle when I move my head side to side." Kybella can both decrease fat and tighten skin in the treated area. "We have found skin tightening as well as a decrease in submental volume with Kybella," says Dr. Kirby. "We usually do two treatments, but sometimes it takes three or four. Treatments need to be about eight weeks apart because it can take that long to see fi nal results," Dr. Gilbert fi nds that Kybella works well, but says, "Patients need to understand that signifi cant bruising and swelling can last as long as a week. If there is enough fat, we prefer CoolSculpting because the results are just as good, with less downtime." The best tool for the job depends on the patient, says Dr. Kilmer. "Kybella is great for smaller areas of fat when the CoolMini won't fi t, but the CoolMini is fabulous for larger areas," she advises. For patients who need debulking, Dr. Narurkar starts with the CoolMini and then follows by contouring with Kybella. In April 2016, Allergan purchased Topokine Therapeutics, which has been working on Topokine Gel, a topical using a proprietary active called XAF5 technology to get rid of the fat in undereye bags. XAF5 is also in phase 2 trials as a treat- ment for submental fat under the chin. "I wouldn't be surprised if a number of new treatments are available in two or three years," says Dr. Shelton. "What we have now works but not as well as it could, and I know manufacturers are looking for more effective modalities with no downtime for neck and chest treatments. Patient demand drives innovation." Linda W. Lewis is the contributing editor of MedEsthetics. 46 SEPTEMBER 2017 | MedEsthetics BEFORE 10 WEEKS AFTER TREATMENT 12 WEEKS AFTER TREATMENT Submental fat reduction and skin tightening following Kybella injections in the chin. PHOTOS COURTESY OF EMILY J. KIRBY, MD

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