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Before Kybella’s approval in 2015, there was only one option for treating the double chin: submental, or chin liposuction.  Since then, however, Kybella has added an alternative and has thoroughly complicated the decision.  Chin liposuction is the physical removal of fat via a suction cannula that is introduced through the skin through a small incision in the chin crease.  Kybella, on the other hand, is a medical-grade surfactant, or detergent.  Much like soap disrupts grease, Kybella works by physically turning fat cells inside out, leaving your body to “clean up” the resulting mess.  Which option is better?  Both.  Both, when delivered by experienced hands, can deliver excellent outcomes with natural-looking and feeling results with good longevity.

Ideal Candidates

Both chin liposuction and Kybella have the same ideal candidates: patients with a small or moderate amount of submental fat (double chin) with good, tight skin quality in this area.  Patients with skin laxity in this area tend to not have great results, because fat removal can lead to a “hollow” look, with more sagging skin than before treatment.  For these patients, a chin lift, or submentoplasty, can tighten the muscles of the neck, and a neck lift can tighten and remove extra skin for a more defined neckline.

Treatment

Chin Liposuction is typically a single treatment with a single recovery period, which can last up to 2 weeks, though many people are back at work after one week.  This procedure typically involves numbing shots and often times some pills to relax you for the procedure.  Once the skin is cleansed with soap, the procedure takes between 10-45 minutes to complete depending on the complexity and amount of fat to be removed.
Kybella is typically delivered over multiple sessions, with 1-3 vials per session injected.  Treatment consists of applying a numbing cream for 20-30 minutes, followed by the removal of this, applying a skin grid.  Injecting the Kybella typically takes 5 minutes or so.  This is described as an “uncomfortable” treatment, not due to the needle insertions (which the skin is numbed to), but rather because of the reaction it causes to the fat cells.  Remove the grid marks, apply a cold pack, and you are out the door.

Recovery

After a chin liposuction procedure, patients go home with a chin strap dressing, which is worn for the first week, and then at night for the following week.  Some patients may have bruising and swelling, and the risks of these is dependent on the amount of reduction we are trying to achieve.  We avoid heavy lifting for the first week, and otherwise, patients resume their normal activities.  Most patients typically return to work the following week, though this depends heavily on patient preferences and the type of work involved.
A Kybella treatment is just the start of the fat reduction.  After a treatment, there is swelling, tenderness, and redness of the neck, which can be visible for 3-5 days after the treatment.  The discomfort is typically not too bothersome, and if a treatment is done late in the week, then people usually return to work on Monday.  The bruising risk is a little less than chin liposuction, though it can be seen with either method.  The downtime depends on the amount injected and the amount of fat being treated and typically decreases after the first treatment.

Downtime

This is the big difference between the treatment modalities.  The downtime of one week with chin liposuction is a “one and done”, with gradual recovery after the treatment.  If you can work from home, at an office where you do not feel self-conscious about wearing a chin strap, or are not sensitive to people around you knowing that you had a procedure done, then this may be the most economical procedure for you.  Also, my quoted “one week” of downtime has not proven true for most of my patients, who are working the day of the procedure or the following day, and back to their normal day to day activities (within reason).
The total downtime of Kybella tends to be longer with our typical patients that require 3 treatments, as you figure 3-5 days multiplied by 3.  The timing of the downtime, however, can be picked to coincide with weekends, making for fewer missed days of work.  This is one of the major factors that sway people to Kybella in my practice.  Even when done in the middle of the week, a Kybella rarely keeps people from going to work the next day.

Results

The best results after chin liposuction are obtained 9-12 months after the treatment, as there is a fast process of fat removal, along with a slower process of the scarring under the skin that tightens and remodels over this time period.  Kybella takes 6 weeks or so to see the results from a treatment, but I have seen the best results at the 6-9 month period.
The bottom line is that both methods can deliver great results for most of us.  The skill of the practitioner and the judgment required of the treatment, whether it is the amount of fat removal or quantity and distribution of Kybella, is the most important predictor of success with any procedure.

Cost

Chin liposuction is more of a “fixed cost” service, and Kybella depends on the number of vials needed to get a certain result.  Therefore, patients with a small amount of submental fat may actually be better served by Kybella.  If they can be treated with less than 4 vials, this is a great option, though this tends to be a minority of patients.  As the amount of fat removal increases, the cost of Kybella gets quite high, and chin liposuction tends to be the winner in most of the patients that I see.
Kybella does offer a unique “pay as you go” option, with the ability to sculpt the neck vial by vial, which liposuction cannot do.  One risk is that expectations about what Kybella can accomplish may not be as clear between a patient and an inexperienced practitioner.  This can lead to a Kybella frustration followed by liposuction to “finish the job”, which is the most pricey option.
The way to avoid this is to make sure that the skill and training level of the person performing the treatment is as high as you can get.  To avoid getting a biased opinion, make sure to get an opinion by someone that gets good results from both procedures, as it is this group that can steer you to the best treatment for your face.  Asking someone that injects Kybella and does not do liposuction for an opinion is like asking McDonald’s if you should order a burrito.