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Dr. Elizabeth Roche, founder of the Elizabeth Roche MD MedSpa in Bergen County, New Jersey discusses submental fullness AKA double chin.

John Maher: Hi, I’m John Maher. I’m here today with Dr. Elizabeth Roche, founder of the Elizabeth Roche MD MedSpa in Bergen County, New Jersey. The Medical Aesthetics Center committed to providing people with the most advanced procedures available to restore youth, while preserving the beauty and functional health of your skin. Today our topic is submental fullness. Welcome, Elizabeth.

Elizabeth Roche: Oh, thank you, John.

What Is Submental Fullness?

John: Sure. So Elizabeth, what is submental fullness? What does that mean?

Elizabeth: Submental fullness is basically a technical term for a double chin. Some people have a genetic disposition for extra fat cells to accumulate under the chin, which leads them to have a tendency to have like a full appearance there. For these patients, there are treatments that can be given to reduce the fat in this area.

Other people, they may have an overall weight problem and these treatments that we’ll be discussing are not for those patients who need to lose fat everywhere. It’s for the patients who have an area of excess fat in this one particular spot. It is a very popular area of concern, both for men and women. And they present to my office to have this area treated to improve their profiles and neck line.

Submental Fullness Treatment Options

John: Okay. So what are the treatments that you have available that do treat this problem with submental fullness?

Elizabeth: So there are several treatments available that have scientific backing and have shown to make significant change for the double chin. Including the traditional surgical correction known as liposuction, which I don’t do. I do nonsurgical treatments. The treatments that I offer include SculpSure and Kybella.

Although liposuction works very well and is considered the gold standard for this problem, remember it is a surgical procedure that is invasive. And has a higher risk of complications and also a greater healing time. Both SculpSure and Kybella treatments are quick and are performed in my office in about 30 to 40 minutes, and also have much less downtime.

SculpSure Treatment for Double Chin

John: So let’s talk about each one of those. Let’s start with SculpSure. What is that SculpSure treatment like? And what is it that you do when somebody comes into your office for a SculpSure treatment?

Elizabeth: SculpSure is also known as warm sculpting. It is a treatment that melts fat using laser technology. It is a machine with, we’ll call it forearms and attached to those arms are four transducers, and they’re about the size of small cellular phones. And they are applied to the skin on the body. Or in this case one, of those transducers are applied to the area under the chin to treat the submental fullness.

When the treatment begins there is an initial cooling sensation. Then warmth sensation gradually builds up over time to the point of a heat sensation. Some patients tolerate it easily, while others report an intense heat sensation, which may cause some discomfort. We adjust the input based on the patient’s feedback using a sensation scale of one to five with the optimum level being a four out of five. This is the level that is going to target that fat and start melting the fat.

The heat will weaken the fat cells or the adipose cell wall. Over time the cell breaks down and the liquid fat is released. The lymphatic and circulatory system then comes in and picks up the fat and it’s metabolized by the liver and excreted out of the body. A treatment is about 25 minutes long. And patients can leave immediately after the treatment without any significant downtime.

Not all, but some of the patients report swelling for a week and rarely more than that. The patients can expect a reduction of up to 24% of the fat, with results being noticed at about six weeks. But the continued results occur for over a 12 week period of time. Multiple treatments are usually required for optimum results. But the number of treatments really depends on how much fat needs to be reduced.

John: Okay. And you mentioned that you have this one to five scale of the heat sensation as you’re doing the procedure and you’re shooting for maybe a four. So as you’re doing the procedure, you have the patient call out, “Oh yeah, okay, that feels like it’s heated up and I’m feeling like kind of a three and then a four.” Then if they hit five, do you stop? How is it that you handle that during the procedure?

Elizabeth: So we are in the room with the patient the whole time and there’s continuing communication back and forth. We actually give them a card which has … it’s a color coded card. And it has the scale of zero, one, two, three, four and five. So they use that and it describes just a slight prickling, like a more intense warmth, deeper intense heat. So it has not only a visual, but a verbal description there. And we are gradually increasing the energy based on the patient’s response.

So we’ll program the machine to deliver a little bit more energy over time. And if they get to a point where they’re like, “Okay, I can go up,” but then they decide, “You know what, I can’t tolerate this level anymore,” we could always bring it down again to a level that’s more tolerable. So it’s all based on communication and adjusting the machine’s energy.

Kybella for Double Chin

John: Okay, that’s interesting. So let’s move on to Kybella. Is that a very similar procedure or is that different? And how is it different from SculpSure?

Elizabeth: Kybella is a medication that’s injected into the fatty tissue. The medication acts like a detergent, which weakens and breaks down the fat cell over time. So it’s similar in that they both weaken the cell wall, one by a heat, but Kybella is more of a detergent. Just like dish detergent breaks down the grease on your dishes, this is a medication that’s injected and it targets the cell wall and breaks the fat cells down.

It requires multiple small injections of the medication, similar to how Botox is injected. But instead of targeting the muscle like we do in Botox, we are targeting the fatty tissue layer. About 30 minutes prior to the injection, a topical numbing cream is applied to decrease the insertion sensation of the needles. We also use some cold compresses, which helps with comfort. Once the medication is injected, there may be a brief period of burning which lasts less than five minutes. And once again, we’ll put cool compresses on it.

Because this is an injection, there is a risk of bruising as all injections have. There will be some swelling, especially since fluid was injected into the area. It can be anywhere from, depending on how much fat is there, we may be injecting two CCs or four CCs, five CCs. We can inject up to 10 CCs. So that fluid in there under the skin and the fat is going to add to a fullness or swelling appearance initially.

The Kybella medication will be absorbed. However, there may be several weeks of swelling as the fat breakdown process proceeds. The results will begin to be seen at six weeks. And once again can take up to 12 weeks to see the end results. And the treatment can be repeated at the eight week point.

John: Okay. And you said that the injection specifically targets the fatty tissue layer under the skin. How is it that you specifically target that layer?

Elizabeth: Well, you need to know your anatomy and you need to understand what layers are under the skin, fat, muscle. It’s all about the depth. There is a little nuance as you get experienced of the feel, you can actually feel with the fine needle, what layer that you’re in of the skin or under the skin. So it’s based on training, experience and knowledge of anatomy to know where to place the medication.

Which Treatment Option Is Best?

John: Okay. How would you decide which treatment might be better for a patient, whether you use SculpSure or Kybella? And do you ever do a combination of those?

Elizabeth: That’s a great question and I get that question from patients when they come in. During the consultation I will assess exactly where the fat is. I also question them about their medical history, any current medications that they’re on, that may lead me to recommend one treatment over the other. I will also ask questions about what they do in terms of their profession or their social life because there may be differences in the downtime. And if they are all right with the risk of possible bruising. That would be with the injection of Kybella.

In assessing the patient, sometimes the apparatus for the SculpSure machine will not fit properly on the submental area. If somebody’s very petite or their fat is not quite right underneath the chin but more in front of the neck, the SculpSure machine may not fit on correctly. So in that case I would just choose the Kybella. If there’s not a factor and all else is equal, in general, I get a feel for the patient’s personality and their reactions as I describe each of the treatments.

Many times after describing what is involved in each treatment, the patient may have a preference as to which treatment they prefer. If there are no contraindications, then that’s the one we usually agree to do. And yes, I have also done a combination of treatments on patients, treating them both with SculpSure and Kybella, but not at the same appointment time. We’ll space it out and do several weeks later doing one or the other.

John: Maybe even do SculpSure, wait the six weeks and see what the results are and then do Kybella as an additional treatment, something like that?

Elizabeth: Yes, exactly. Sometimes you want to do a general bulking down of the fat, and SculpSure is great for that. And then you can do a little more finessing with Kybella. I’ve actually used Kybella on patients who have had prior liposuction. Liposuction sometimes does not come out perfectly even, and there may be like a little fat pocket left. So instead of undergoing surgery again, a patient would come in and just have that one little area treated with Kybella.

Once again, sometimes it takes one treatment. Sometimes it may take several treatments. But it’s a small little amount that’s injected, specifically in that little fat pocket area that was left over.

Number of Treatments Required

John: You just mentioned that multiple treatments sometimes are necessary with both SculpSure and Kybella. Generally, how many treatments are required?

Elizabeth: The number of treatments for both SculpSure and Kybella depends on how much fat is needed to be reduced. Or in other words, how much baseline fat is there to start with? I’ve also found that an individual patient’s metabolism plays an important part in how dramatically and how quickly the results are achieved. It is recommended to drink plenty of water to flush out the fat after either treatment. And I find that like a gentle massage of the treated area also helps achieve greater and faster results.

When a patient comes in for their consultation, I can better gauge how many treatments may be needed based upon my past experience of treating patients. Most patients at least will have two treatments, whether it be SculpSure or Kybella. But there are many patients that have been happy after one treatment, if they have a small amount of reduction that’s needed.

Results of Submental Fullness Treatment

John: Okay. And how long did the results last? Obviously, after waiting those six weeks or so for the treatments to take full effect, do people need to come back again six months later? Or how often are they repeating the treatments?

Elizabeth: So after their treatment, whatever fat cells have been destroyed, they’re permanently gone. You’re not going to grow back new fat cells. So if you think about fat cells as a cluster of grapes and we’re removing some of those grapes, there will be some fat cells left behind, but whatever has been taken is gone. Whatever has been destroyed, they’re gone.

However, since all fat cells are never completely removed with either treatment, there’s always a thin layer of fat cells there, which is natural and normal to have. If a patient were to gain a significant amount of weight, the remaining fat cells can become bigger when there is a need for the body to store this excess fat someplace if it hasn’t been burned. But most likely this fat will be stored somewhere else in the body. They may find that, “Okay, I’m not gaining the weight under my chin, but okay my thighs are getting bigger, or my arms are getting bigger.”

But most of my patients are very conscientious after going through a fat reducing procedure to have a healthy lifestyle and decrease or maintain their calorie intake so they’re not gaining weight. The best way to retain the results is to keep your overall weight in check with proper diet and exercise.

John: All right. Any final thoughts on submental fullness and reducing your double chin with one of these treatments?

Elizabeth: Well, I think that it’s a great treatment to have a more defined profile. Even in this day and age where we’re doing a lot of at home conferences, conference calls, it’s nice to be seen on the screen with a nice defined chin line and neckline. It’s a very popular treatment. And I look forward just to talking to anybody about this concern they have.

John: All right, well that’s really great information, Elizabeth. Thanks again for speaking with me today.

Elizabeth: Thanks for having me, John.

John: And for more information about submental fullness, Kybella and SculpSure or other treatments, visit the website at elizabethrochemedspa.com or call (201)- 505-1020.

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