The makers of Botox want to get rid of your double chin

Published 1:38 pm Friday, April 22, 2016

The next fat profit center in the pharmaceutical industry may be the double chin.

Allergan is beginning an aggressive sales blitz for Kybella, the first injectable treatment for what the medical industry terms “submental fat” and you probably think of as your jowls.

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“It’s a disruptive technology,” said Philippe Schaison, president of Allergan’s U.S. medical business. “It’s working great, and there’s nothing like it.”

Scientists at Kythera Biopharmaceuticals worked on Kybella for roughly a decade. Soon after the Food and Drug Administration approved the chin treatment, in April 2015, Allergan moved to buy Kythera for $2.1 billion in cash. The giant drug maker has trained roughly 1,600 doctors in the U.S. and Canada to administer Kybella, an effort that will expand if European Union regulators approve the drug this year, as the company expects. Allergan is putting together a September television advertising blitz.

Kybella’s active ingredient, deoxycholic acid, is a form of bile that destroys fat cells in the digestive tract and, it turns out, in the chin. The treatment involves 20 to 30 tiny injections by a doctor, who must avoid nerves and major blood vessels running under the jawline.

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Most patients require two to four sessions, each costing $1,500, Manhattan dermatologist Anne Chapas said. Her practice, Union Square Laser Dermatology, performs a few Kybella treatments a week. “We’ve been hearing about this for over 10 years, so we were absolutely excited about it,” Chapas said. “We know there’s huge potential.”

Kybella will shore up Allergan’s strong position in the booming market for aesthetic treatments, a segment that Sanford C. Bernstein expects to grow at 10 percent a year through 2020, faster than any other Allergan business. For eye wrinkles, the company sells Botox-by far its most lucrative product, with $2 billion in 2015 sales. For more dramatic cheekbones, Allergan offers so-called dermal fillers such as Voluma.

The next move in Allergan’s descending conquest could create the largest aesthetic market yet. In preliminary trials, the company says, Kybella proved effective in 80 percent of patients.

“This is an area that for a lot of people is just a genetic problem,” said Chapas. “It happens in plenty of people that are thinner or normal weight.”

Few chin-slimming alternatives are available. Liposuction, the most popular option in the U.S. market, costs about $6,000 and involves an incision, at least a few days in bandages, and occasional scarring.

Allergan’s Schaison already has a name for the combination of Botox, dermal fillers and Kybella: the liquid facelift. All three treatments use needles, not knives. “Now we’re almost a one-stop shop,” he said. “We own the face.”

Shcaison isn’t just president of the company pushing the no-cut facelift; he’s also a client, the second person in Allergan to receive a Kybella treatment. “I was not bothered by my chin, but I wanted to experience it,” he said of the 10-minute procedure. “I absolutely loved the results.”

Unlike Botox, the effect of Kybella doesn’t wear off in a few months. That means the revenue stream is short. But the chin drug has far broader appeal than most treatments on the menu at the plastic surgeon or dermatologist’s office.

Elizabeth Krutoholow, a pharma analyst with Bloomberg Intelligence, estimates Kybella would be appropriate for two of three patients who visit a dermatologist. Canaccord Genuity analyst Corey Davis predicted it will draw new types of consumers, with potential to appeal to men and middle-American consumers. Allergan said men will probably constitute 30 percent of Kybella patients, compared with only 10 percent of Botox users. The forthcoming ad campaign will be fairly gender-neutral, Allergan said.

That broad potential has made it difficult for analysts to forecast the drug’s sales. Allergan believes Kybella could eventually become a $1 billion business, roughly half the company’s current Botox revenue. Krutoholow is forecasting $500 million in annual sales, and Sanford Bernstein expects the treatment to garner $306 million a year by 2020.

Of course, even a billion-dollar chin business would be fairly tiny next to erectile-dysfunction pills, which garnered $4.3 billion in worldwide sales last year. But Kybella should quickly blow past Prozac (depression), Propecia (hair loss), and Prilosec (heartburn).

And why stop at your face? Allergan is already testing whether Kybella might be safe and effective in arms, knees and love handles.

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