Kybella is an FDA approved cosmetic injection indicated for improvement in the appearance of
submental fullness associated with submental fat in adults. The results of Kybella are not
immediate. At your first treatment visit you will receive a series of injections in the submental
area. At the time of injection and for several days following the injections you will have swelling
in the submental area. Kybella will cause the fat cells to diminish gradually over the course of
the next month following your injection in the treated area. A series of treatments may be
necessary to achieve optimal results and these will occur at no sooner than the one month
interval. Your Registered Nurse will decide the appropriate number of treatment sessions and the
amount of Kybella you will need at each session.
Side Effects: Side effects of Kybella may include: bruising, swelling, numbness, induration,
marginal mandibular nerve injury, dysphagia (difficulty swallowing), bleeding, tenderness or
discomfort, tissue necrosis, hyperpigmentation, redness, or alopecia at the site of injection.
Alopecia: Kybella injections could cause small patches of alopecia in the treatment area.
Pre-Instructions: You should not be pregnant, nursing an infant, have a history of a bleeding
disorder or infection of the area to be treated. The morning of your treatment you should take
ibuprofen if you are able to tolerate this medication. Also, you should tell the nurse if you take
any blood thinners or aspirin or have a history of any issue with lidocaine or epinephrine.
Post Care Instructions: • Ice packs may be used to the treated area during the first 12 hours – ice
for 15 minutes on every hour • Do not massage the injection site • If you are able to tolerate
ibuprofen take 200mg three times daily beginning the day of your treatment and for the
following four days • Avoid heavy exercise the day of your treatment
Notify Beautox Bar LLC if any significant, swelling, bleeding, pain, dusky discoloration,
difficulty swallowing or smiling, or fever occurs.
Alternatives: As explained not all submental fullness will respond to Kybella. Other alternative
treatments are liposuction to the area, a neck lift and/or platysmoplasty procedures.
I CONSENT TO THE TREATMENT OF KYBELLA INJECTIONS AND I HAVE READ THE
ABOVE LISTED ITEMS. I AM SATISFIED WITH THE INFORMED CONSENT PROCESS.
Patient or Person Authorized to Sign for Patient