At the end of last April, the Food and Drug Administration (FDA) published a press release announcing the approval of a new injection called Kybella. The injection was legally approved to be used as an alternative to liposuction, for a very specific purpose: It was approved to zap moderate-to-severe chin fat, or the dreaded "double chin."
"Kybella is identical to the deoxycholic acid that is produced in the body," the FDA explained. "Deoxycholic acid produced in the body helps the body absorb fats. Kybella is a cytolytic drug, which when injected into tissue physically destroys the cell membrane. When properly injected into submental fat, the drug destroys fat cells; however, it can also destroy other types of cells, such as skin cells, if it is inadvertently injected into the skin."
Like all other injections, Kybella comes with a hefty price tag (ranging from about $2,000 to over $4,000 for the three treatments, matching what it costs to get liposuction in your neck)—and multiple side effects, such as "nerve injury in the jaw that can cause an uneven smile or facial muscle weakness, and trouble swallowing."
In the months after the product's debut, readers of the premiere plastic surgery information and review site, RealSelf, became curious about whether Kybella could work on other parts of the body. Specifically, readers wondered if the injection could help them achieve the elusive "thigh gap": the space formed between a woman's legs even when she stands with her feet together. Although the thigh gap has been expected of fashion models for decades, social media platforms like Instagram and Tumblr really began to bring pressure—and a widespread thigh gap obsession—to the general public around 2013. Blogging platforms and social media sites also gave pro-anorexia groups an easy place to trade tricks, tips, and therapy in total anonymity, and daily memes about thigh gaps became part of many women's daily Internet routines. There was a Twitter account devoted to supermodel Cara Delevingne's thigh gap, and pages and pages of Tumblr posts encouraged girls to work hard to achieve a space between their legs. Women published essays everywhere from the Guardian to VICE grappling with the notion of this seemingly impossible mark of thinness and beauty. The fact is that without rigorous work—a strict diet and celebrity-level personal training—and/or specific genetics, a thigh gap is not that easy for most adult women to get. You have it or you don't, or you shell out for surgery.
Since the summer, RealSelf reported Kybella and related searches up 50 percent, making it one of the top five key searches on the plastic surgery site. On a forum thread titled, "Kybella for the inner thigh gap?" potential customers and surgeons talked back and forth about the possibility of using the double-chin corrector for something the FDA specifically has not given it the green light for. "Using Kybella for the treatment of fat outside of the submental area is not approved and is not recommended," the FDA stated in its original press release. Doctors responded to patients' queries pretty unanimously: While there is the possibility that using Kybella to get a thigh gap could create medical difficulties, there are also practical concerns: It would cost a lot.
"When Kybella hit the market, the only alternative was liposuction," says Dr. Sheila Nazarain Mobin, a plastic surgeon based in Beverly Hills. "[Drug companies] knew they had a captive audience in those who were afraid of invasive surgery. They priced it in the neck area so it would be comparable to liposuction."
Besides, there's a better way to procedure your way to a space between your inner thighs. The year before Kybella hit the market, another non-invasive product called CoolSculpting received FDA approval to treat thigh fat, though it was initially developed for the abdomen; the following year, in September, it was approved to do the chin. It created the same results for far less money, pain, and time.
"Kybella only makes sense for very small areas of fat," says Nazarian. Larger areas—and "moderate-to-severe" fat—require more treatments and experience "bullfrog swelling" in the aftermath because Kybella is a synthetic version of the natural chemical that bursts fat cells. "Your body is not used to having fat exploding in areas other than your gut, so it sends a lot of inflammatory cells over [to the problem area] to try to clean up the mess," explains Nazarian. "We have these cells called microfusion cells, which are basically janitors—they are constantly trolling the body looking for dead cells to [turn over to] create healthy, new cells. So [Kybella] is taking advantage of that inflammatory response to get rid of the blown-up fat. We need the inflammation to get the janitor cells there to clean up the mess."
[Drug companies] knew they had a captive audience in those who were afraid of invasive surgery.
Nazarian explains that non-invasive surgery—like that performed on the chin or on the thigh gap—is rarely done in one sitting and takes weeks for the patient to see results. Although the pharmaceutical company priced Kybella to make it appear like a relatively inexpensive procedure, using the drug would result in a $12,000 thigh gap, whereas CoolSculpting is $750 per thigh, per session, and the number of sessions varies depending on your body type and the severity of the fat. If you wanted to go the more traditional route, going under the knife for liposuction would cost $3,000-$4,000 and create quick, seamless results.
But a lot of women do not even want to admit that they have had CoolSculpting done, let alone liposuction for a thigh gap. Kelsey*, a teacher in her mid-20s, has had both her thigh gap and bra bulge (the fat that can accumulate between a woman's breast and armpit) treated by Dr. Nazarian, but she kept it a secret from her peers—even though part of the appeal of these procedures is that they seem "small" and "less serious" than your classic boob job.
"I had always been against any enhancements," Kelsey says, noting too that her procedures were non-invasive and felt like "simple boosts" and not plastic surgery. "All-natural is what I wanted, and I never thought I would have anything done."
Indeed, after her CoolSculpting, Kelsey initially didn't even notice much of a difference in her appearance. "I did not notice a huge change myself, and then people were commenting on how thin I looked," she says. "Other people's comments made a huge difference. The thigh gap is such a small change that can impact your overall appearance so drastically."
Although the thigh gap maintains some of the allure it had a few years ago, the (absence of) body part still galvanizes opinions. Last week, I put up a Facebook post asking friends if they thought the thigh gap was sexy, and the answers varied from calm yes's and no's to fury and philosophy. Some women were angry, saying that anyone who cares about a thigh gap needs to "do some psychedelics" and "expand your mind," while men contemplated, ultimately concluding that, although it might seem strange, a thigh gap does draw attention to nearby areas.
Ultimately, who cares? Joan Rivers once told me that if plastic surgery is going to make you feel better about yourself, then run, don't walk to the doctor. "Thigh gaps are a thing invented by women for women," wrote one commenter. "It's like wanting prominent collarbones. An impossible thing to work towards if you don't already have it. Just another way for women to keep themselves unhappy and striving to be something 'better.'
"That being said," she added, "I fucking wish I had the type of body with a thigh gap."
*Name has been changed.