KYBELLA® (DEOXYCHOLIC ACID) INFORMED CONSENT

Kybella® (deoxycholic acid) is a prescription-strength injection used to treat the double chin (submental fat) in adults. Kybella® destroys the fat cells that accumulate in the neck. The body then naturally eliminates the fat slowly over a few weeks. Once these cells are destroyed, they can no longer store or accumulate fat. Kybella® is prepared at a very controlled solution and when injected into the skin with a very fine needle. Patients may feel a burning sensation while the solution is being injected. The treatment takes about 15 - 20 minutes. Most patients require two vials per treatment and require two to four treatments. Some patients require up to six treatments depending on the amount of fat or until the desired effect is achieved.. Final improvement is assessed twelve weeks after the final treatment.

This list is not meant to be inclusive of all possible risks and complications associated with Kybella® as there are both known and unknown side effects associated with any medication or procedure. The possible side effects of Kybella® include but are not limited to:

• Swelling (edema) in the treatment area (always)
• Bruising (hematoma) in the treatment area
• Pain in the treatment area
• Numbness in the treatment area
• Redness (erythema)
• Areas of hardness (induration) in the treatment area
• Ulceration of the skin in the treatment area
• Temporary or permanent hair loss at the injection site(s)
• Less common side effects include, but are not limited to, tingling, nodules, itching, skin tightness, and headache. These side effects typically resolve without treatment.
• Other less common but serious potential side effects of Kybella include temporary nerve injury in the jaw that can cause an uneven smile or facial muscle weakness, trouble swallowing, superficial skin erosions, small patches of hair loss in the treatment area, or unsatisfactory results.

Kybella® is best used in treatment of the double chin (submental fat). Alternative treatments for a double chin include surgical treatments such as a facelift or neck lift, liposuction, and non-surgical treatments such as energy-based devices. Photographs Clinical photographs shall be used for the patient’s medical record. Photographs are not shared with third parties or used for marketing purposes unless (express) written permission is obtained from the patient.

Kybella® treatments should not be performed on anyone who has an infection in the area. Kybella® has not been studied on women who are pregnant, trying to become pregnant, or breast feeding. Kybella® treatments are not recommended for those with medical conditions in the neck area including, but not limited to, difficulty swallowing, those that are planning to have cosmetic surgical treatments in the neck or face area such as a facelift or neck lift, those with an enlarged thyroid gland (thyromegaly), or those with a bleeding disorder.

The number of vials and treatments is an estimate of the amount of Kybella® required to address the double chin (submental fat). There is no guarantee of results of any treatment and up to six treatments may be needed to achieve a satisfactory result. Follow up is recommended six weeks after treatment.

Payment is due at the time of treatment. All services rendered are charged directly to the patient and the patient is personally responsible for payment. In the event of non-payment, the patient will bear the cost of collection, and/or court cost and reasonable legal fees, should this be required. Touch-ups may be required and payment is required for touch-ups. The regular charge applies to all subsequent treatments. Prices are subject to change without notice. No refunds will be given for treatments received.