Bare shoulders are one of summer’s hottest trends, but, for some, they bring up the pesky problem of “bra bulge.” This small pocket of armpit fat is notoriously hard to exercise away, and there hasn’t been an easy treatment.
That’s why we’ve been intrigued by reports of doctors doing off-label experiments with the injectable Kybella (FDA-approved to eliminate the fat responsible for double chins) to treat stubborn underarm fat. We’ve also suspected that the popular fat-freezing technique CoolSculpting, whose CoolMini applicator is FDA-approved for contouring small areas of pinchable fat, could do the job.
So we asked RealSelf doctors who are intimately familiar with Kybella and CoolSculpting’s CoolMini which treatment is the best bet for women battling bra bulge.
San Francisco doctor Corey Maas, a principal investigator on Kybella’s FDA trials, has performed “500 or more” Kybella treatments so far. Most of them targeted double chins, but he’s currently conducting a trial on off-label uses with about 100 subjects. He says Kybella is highly effective for treating small, isolated fatty areas, especially what he calls the “jog-bra roll.”
Dr. Maas immediately saw off-label potential for Kybella during the FDA trials. “It’s not specific,” he said. “The drug works on fat cells, or lipocytes. It doesn’t matter where the lipocytes are.”
Dr. David Shafer in New York is also testing Kybella off-label, and he agrees. “There are many potential areas of use,” Dr. Shafer told us. “The front bra bulge area is an excellent treatment site. Many women have concerns about this area, and traditional treatments like liposuction often are not warranted.”
So what about CoolSculpting’s CoolMini? Dr. Michele Green in New York has used Kybella for double chins, but she uses the CoolMini for other small areas like bra bulge.
“I’ve done it, and it works great,” Dr. Green said. “I’m scared to use Kybella off-label. I’ve seen doctors try to use it off-label on the legs, different areas, and had severe necrosis, or death of the skin, ulcerations, and scarring.”
“I’m not a cowboy,” she continued. “If you can pinch it, and the CoolSculpting applicator fits, and it makes sense, then yes. It’s kind of scary that people are doing Kybella in off-label areas. Unless it’s tested, and they give the proper dosage, it’s permanent.”
Dr. Green adds that CoolSculpting’s lower average cost (usually $1,000 per treatment vs. Kybella’s $1,500), and virtually no downtime make it a great option.
But the doctors using Kybella off-label like the flexibility of an injectable to eliminate fat and contour lumpy areas, rather than attaching a device.
“I have not tried CoolMini in this area [the bra bulge],” Dr. Shafer said via email. “I have seen too many people with unfavorable or little difference with the fat-freezing technology to warrant incorporating it into my practice.”
All of the doctors agreed that determining which treatment is best for a tough-to-treat spot should be worked out between the patient and a board-certified doctor.
“Off-label use should not be done in inexperienced hands,” Dr. Shafer said. “The patient should be fully informed about off-label use during the consent process.”
Dr. Maas and Dr. Shafer both see future uses for Kybella on areas like inner knees, elbows, ankles, lumps left by liposuction, or even benign fatty cysts.
“CoolMini is limited to the footprint of the device,” Dr. Maas said. “It certainly works for that mass destruction of fat, and you will still have other areas where there is fat remaining.
“What I anticipate with CoolMini or liposuction is that people will probably get these for mass fat destruction, and we’ll be using Kybella to refine or improve outcomes,” Dr. Maas said.