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What to Expect With Kybella Before and After

Kybella is an FDA-cleared treatment that can reduce submental fat (fat beneath the chin and along the neckline) without major surgery. While injections are required, the procedure is far less invasive than surgical chin liposuction, and the results can be stunning.

As you approach Kybella—whether you’re sure it’s right for you or you just want to learn more—it’s wise to become as informed as possible about the procedure. So, below, we’ve provided some useful information on what you can expect from Kybella before and after.

An Overview of Kybella

So, what is Kybella? The active ingredient in Kybella is called synthetic deoxycholic acid. It works by breaking down fat cells in the target area. Once these fat cells are destroyed, the body’s natural metabolic process removes them over time, leading to a slimmer profile in the chin and neck area.

Extensive research was performed before this fat-reducing product was released. Ultimately, the treatment has been found to have excellent results for many patients. It’s one of the best non-surgical options available for fat reduction and, specifically, double chin reduction available today.

What to Know Before Undergoing Kybella Treatment

It’s done in-office and doesn’t take long.

The Kybella procedure is almost always performed in-office. Each injectable treatment typically takes less than 30 minutes. Naturally, you’ll need a consultation to discuss your goals and confirm your candidacy first. The best candidates for this procedure are healthy but have excess chin fat. You should be a non-smoker and not actively undergoing any kind of anticoagulant therapy or related treatments, which could cause excessive bleeding.

Is Kybella really worth it

Your surgeon will need to mark your chin and neck area prior to the injections.

Before injections begin, your provider will carefully mark the area to ensure precise treatment placement. This step is essential to target submental fat effectively. Small injection sites are strategically spaced across the treatment area to maximize fat cell reduction in the chin and neck area.

You may want numbing cream, but discomfort should be mild.

Although not always absolutely necessary, many patients request numbing cream be applied to minimize discomfort. Some patients report a mild stinging sensation as the solution is injected.

Don’t be worried if the treatment area swells significantly.

After the injections, expect some swelling. This is a common response as the body begins breaking down the fat cells. The swelling may feel pronounced for the first few days and can last up to a week. Some professionals say that more swelling means more fat reduction, so embrace this side effect!

What to Know After Undergoing Kybella Treatment

You should be able to return to your normal activities directly after treatment.

Most patients can resume their daily routines immediately after their Kybella injections. While swelling or minor tenderness at the injection site may occur, these symptoms don’t usually interfere with regular activities. In fact, the minimal downtime is one reason Kybella is popular.

Ice packs can help with pain and swelling.

During Kybella recovery, applying ice packs to the treatment area can help alleviate swelling and reduce any lingering discomfort. Never apply an ice pack directly to the skin, and always follow your surgeon’s directions.

It will take some time to see your full results.

Kybella works gradually, and it may take several weeks or even months to see the final outcome. Results depend on how quickly your body processes the fat cells destroyed by the injections. Although initial changes might be noticeable sooner, many patients find that their full results develop over two to three months.

You may need more than one treatment.

While some people see satisfactory results after one session, often, patients require multiple treatments to achieve their desired outcome. Most providers recommend two treatments spaced several weeks apart, though some people require more to completely reduce their chin fat.

FAQs: Before and After Kybella

How soon will I see my desired results after Kybella?

Initial changes may be noticeable after just a few days or weeks, but patience is key. Kybella works progressively to reduce submental fat. Overall, it could take several months to see your full results.

What is Kybella recovery like?

During Kybella recovery, you may have some swelling and bruising. But overall, you should feel fine and be able to return to work and everyday activities. For example, for most patients who receive 1 vial Kybella before and after periods are much the same. You won’t need to totally relax and rest unless you feel like it, and for the most part, you should be free to live your life as usual.

How many sessions of Kybella are needed

How much does Kybella cost?

Kybella cost varies, so we recommend booking an appointment. We’ll need to take a look at your submental area and learn more about your aesthetic goals.

How many Kybella treatments are usually needed?

Most patients require two to four sessions for optimal results, though this varies based on the individual’s submental fullness and desired outcome. Treatment sessions are typically scheduled one to two months apart to allow for healing and maximize fat reduction.

Will Kybella help with skin laxity under the chin?

Kybella is designed to target fat, not loose skin, so it may not address skin laxity. Patients with concerns about skin firmness might want to discuss options with their provider for additional treatments that specifically target skin tightening and would offer maximum results.

Learn More at a Personal Consultation

If you do decide to get Kybella before and after chin reduction you are of course always free to ask questions. Double board certified plastic surgeon Dr. Sieber and his team are here to support you as you learn more about plastic surgery and what procedures will work best for you.

We always want to ensure that our patients experience the best visits when they come to see us for the aesthetic treatments. Please take a moment to read our reviews from actual patients and to look at our Kybella chin before and after photos.

You deserve to achieve your aesthetic goals, and we can help you get there! Contact us today to book a consultation.

References

  1. https://www.allerganaesthetics.com/treatment-areas/facial-aesthetics

Does Kybella Cost Less Than Chin Liposuction?

What does Kybella treatment cost?

Cost is always one of the first topics we receive questions about when it comes to our cosmetic procedures. Unfortunately, we can’t give you an accurate estimate on the cost of a prospective Kybella treatment session over he phone. This goes for any cosmetic procedure.

Instead, it’s important that we meet with you in person first. This is because Kybella treatment costs are directly related to how much subcutaneous fat the patient has (Kybella destroys fat cells), which treatment session you’re on (sometimes, multiple sessions are needed), what your goals are, and other factors.

Before we go deeper into cost, however, let’s explore the surgery in general. What is Kybella?

An Overview of Kybella

is kybella fda-approved

Kybella is an FDA-cleared injectable treatment designed to reduce excess fat beneath the chin. Although it can sometimes be used on other parts of the body, it primarily targets submental fullness (often called a double chin). Specifically, the procedure uses injections of deoxycholic acid, which is a naturally occurring molecule, to break down fat cells, which are then absorbed by the body.

This is an excellent non-surgical approach to fat reduction beneath the chin. Patients who are worried about undergoing a surgical procedure or those who don’t want to pay the price of chin lipo are often great candidates for Kybella.

Does Kybella Cost Less Than Chin Liposuction?

For patients looking to reduce a double chin, Kybella and chin liposuction are both popular options. With that said, they differ in approach, recovery time, and overall expense.

Let’s review Kybella. This is a non-surgical, injectable procedure that breaks down fat cells under the chin. It does this, typically, in multiple treatment sessions. While each Kybella treatment session can target submental fat without incisions, the cost of the multiple sessions can add up.

On the other hand, chin liposuction is a surgical approach that removes excess fat directly from the treatment area. It only takes one procedure.

The cost of Kybella versus chin liposuction varies significantly based on the number of Kybella treatments required, the extent of fat reduction desired, and other factors. Because chin liposuction only requires one procedure and because it is surgical, it tends to cost more and involves surgical fees, anesthesia fees, and sometimes, aftercare fees.

In the end, many patients like that Kybella offers a more gradual pay schedule, with costs that tend to be lower overall and which do not need to be paid all at once.

Factors That Impact the Cost of Kybella vs. Chin Liposuction

Exact prices must be discussed with your surgeon as all surgeons charge different prices, and every procedure and patient will be different. Overall, one Kybella treatment session will be less expensive than a chin liposuction procedure. However, again, you’ll probably need multiple Kybella treatment sessions.

Naturally, this means that the number of Kybella treatments a patient needs directly impacts the total expense. Patients with significant submental fullness may need four or more Kybella treatments, increasing their cost per session. Although Kybella recovery is generally quicker and patients like that and that it’s non-surgical, costs can accumulate over these multiple sessions.

Chin liposuction is more expensive because it carries more risks and involves more serious medical procedures such as the administration of anesthesia, incisions, incision closure, and the liposuction procedure itself, which involves inserting a thin metal tube into the treatment area and physically suctioning out fat.

Ultimately, the choice is between you and your surgeon. There are certainly advantages to both Kybella and chin liposuction.

FAQs: Kybella

is kybella safeHow much does Kybella cost per session?

The cost of Kybella treatments varies depending on the provider and the amount of fat reduction needed. Most patients pay per session. But while it may have a lower session cost compared to chin liposuction, the total expense can add up with each additional session.

Does Kybella work on other areas aside from the chin?

Kybella was primarily developed for the chin area to treat submental fat, but some providers also use it to target other small areas of fat on the body. For larger areas, liposuction is the preferred method of fat reduction.

Is Kybella recovery time shorter than chin liposuction recovery?

Yes, Kybella recovery is generally quicker and involves less downtime than chin liposuction. While some swelling and tenderness can occur at the injection site, most patients can return to their regular activities shortly after the Kybella procedure. On the other hand, chin liposuction may involve a longer healing period and more visible bruising and notable discomfort.

How many Kybella treatments are usually needed for best results?

Most patients require at least two to three Kybella sessions for visible fat reduction, though the number of treatments varies depending on your goals and anatomy.

Book Your Consultation Appointment Today

If you have excess chin fat causing a double chin, you may feel self-conscious about this, and that can limit you in other areas of your life. You may feel more embarrassed in social situations, worried about getting your picture taken, or like you don’t deserve that promotion at work. Kybella is a simple, non-surgical treatment that can help.

At the office of double board-certified plastic surgeon Dr. David Sieber, we offer this procedure. Contact us today to learn more about Kybella and find out if you’re a good candidate. We look forward to seeing you at your consultation appointment.

References

  1. https://www.webmd.com/beauty/what-to-know-about-kybella-injections

What to Expect During Kybella Recovery

Kybella treatments can reduce excess bulk beneath your chin and along your neckline without invasive surgery. This way, we can reduce pain, eradicate the need for incisions, prevent scars, and still get you the great outcome you desire.

The Kybella procedure itself typically takes just fifteen to thirty minutes. It’s a quick and generally pain-free experience. Still, it’s important that patients know what they should expect post-treatment and that they follow their aftercare instructions carefully during the recovery process.

Below, we outline what you can expect during Kybella recovery. But first—let’s take a closer look at the Kybella treatment in general and how it is performed.

Kybella Overview

So, what is Kybella?

Kybella is a minimally invasive treatment designed to reduce excess fat beneath the chin, often referred to as a double chin. The procedure uses deoxycholic acid, a naturally occurring substance, to break down fat cells. The body then naturally absorbs and removes the cells. For many, Kybella injections are a good alternative to surgery (chin and neck liposuction).

Who Is a Good Candidate for Kybella?

Good candidates for Kybella include those with moderate to severe fat beneath the chin who want a non-surgical solution.

Individuals who prefer a gradual fat reduction, rather than a more immediate result from surgical procedures like chin liposuction, often find Kybella treatment appealing. It’s important to discuss your goals and medical history with a qualified provider to determine if this fat-dissolving treatment is right for you. Patients should have realistic expectations and be in good overall health.

When Is Chin Liposuction the Preferred Treatment?

Chin liposuction is sometimes preferred for individuals who want faster results and have larger areas of fat to treat. Unlike Kybella, which requires multiple sessions and gradual reduction, liposuction removes fat immediately with one session. This option may be better suited for individuals comfortable with a more invasive procedure and a longer recovery period.

kybella recovery time

Kybella Recovery Time

Common Recovery Symptoms

As far as Kybella recovery day by day, it’s normal to experience swelling, tenderness, and sometimes slight bruising at the injection sites. Kybella swelling can peak within the first few days but usually improves significantly within one to two weeks.

Patients may notice firmness in the treated area as the deoxycholic acid works on fat cells, but this sensation tends to subside gradually over a few weeks.

Can I Continue with My Typical Daily Routine After Kybella?

Yes, most patients can return to their regular activities immediately after Kybella injections. However, it’s best to avoid any activities that could irritate the injection site over the first few days.

Can I Exercise After Kybella?

While most daily activities can be resumed right away, it’s recommended to avoid strenuous exercise for at least one to two days after Kybella treatment. This brief rest period helps reduce swelling and allows the treatment area to settle. Light activities like walking are typically safe, but high-intensity workouts should be avoided.

Kybella Results: Give It Time

Visible results from Kybella take time as the body needs to process the treated fat cells. Initial swelling may obscure the final result, which usually becomes more noticeable a few weeks after treatment. Many patients require more than one session to achieve their desired results, so it’s common to plan for a few treatments spaced about a month apart.

FAQs: Kybella Recovery

How long does swelling last after Kybella?

Swelling after Kybella treatment is normal and typically lasts about one to two weeks. While the first week often shows the most noticeable swelling, it decreases day by day. Applying cold compresses and keeping your head elevated can help reduce swelling (check with your provider first, of course).

kybella recovery day by dayIs there any pain after Kybella injections?

Mild discomfort, such as tenderness or a warm sensation in the treated area, is common after Kybella injections. This usually goes away within a few days, and over-the-counter pain relievers can help reduce any lingering discomfort. Severe pain is uncommon.

How many Kybella sessions are needed?

Most patients require at least two to three Kybella sessions for optimal results, but this varies depending on the amount of fat on the neck and chin. Some may see improvements after the first session, while others may need up to six treatments.

The recommended interval between sessions is typically one month to allow proper recovery. Of course, this will depend on your Kybella cost, your budget, time constraints, and other factors.

Can Kybella results be maintained?

Kybella results are long-lasting as the treated fat cells are permanently reduced. However, maintaining a stable weight is important, as future weight gain can affect the appearance of the treatment area.

Call to Book a Consultation with Us

Regain your confidence by getting rid of your double chin with Kybella. This nonsurgical procedure is ideal for patients with moderate to severe fat beneath the chin.

No incisions. No scars. And a virtually pain-free experience for nearly all patients. See Kybella before and after photos for examples of how this procedure reduces bulk and creates a more defined jawline.

Contact us today to learn more about Kybella and schedule your consultation appointment! Board-certified plastic surgeon Dr. David Sieber and his experienced team look forward to hearing from you.

References

  1. https://www.mykybella.com/frequently-asked-questions

What Is Kybella?

Not everyone was born with a perfectly defined jawline. Furthermore, no one can stop the hands of time. And as one ages, it’s not uncommon (especially for those whose weight has fluctuated) to end up with excess fat beneath the chin and neck.

Fortunately, a nonsurgical procedure that injects a substance called Kybella into the neck can reduce fat cells in this area and give patients a more defined neckline.

So, Kybella what is it? Let’s explore more about this amazing injectable product and what it can do for you if you struggle with a double chin.

What Is Kybella Treatment?

The Kybella procedure is a non-surgical injectable treatment designed to reduce moderate to severe fat beneath the chin, also known as submental fat or a “double chin.” Kybella injections are an FDA approved injectable treatment.

The active ingredient in Kybella is synthetic deoxycholic acid, a naturally occurring molecule that helps break down and absorb fat. When injected into the fat beneath the chin, Kybella basically destroys the fat cells there. This results in a slimmer and more contoured profile.

The treatment is quick, minimally invasive, and requires little to no downtime. Please see our Kybella before and after photos for examples of what this treatment can do.

what is kybella treatment

What Is Kybella Used For?

Kybella treatment is primarily used to reduce submental fat beneath the chin. It can provide a noticeable reduction of a double chin.

Kybella treatments are ideal for individuals who feel self-conscious about their chin area and want a non-surgical option to remove excess fat. Having excess subcutaneous fat on the chin is nothing to be embarrassed about. It’s often the result of genetics, aging, weight fluctuations, etc.

While it’s mainly used for cosmetic treatments on the chin, some doctors also apply Kybella off-label to target small pockets of fat in other areas of the body, such as the jowls or around the knees. However, its primary FDA-approved use remains for chin fat reduction.

Kybella Procedure Steps

The Kybella procedure begins with your surgeon marking the injection sites beneath the chin. A numbing agent is applied to minimize discomfort, followed by multiple small injections of Kybella directly into the fat. Once the dietary fat has been destroyed, the fat cells clear into the lymphatic and circulatory systems.

The number of treatments varies depending on the amount of fat being targeted. The treatment typically lasts around fifteen to thirty minutes, and there is minimal downtime afterward, allowing patients to return to most activities the same day.

Kybella Risks

As with any cosmetic treatment, Kybella does come with certain risks. The most common side effects include swelling, bruising, numbness, and redness at the injection site, which can last for a few days or weeks.

Less common but more serious risks include nerve injury in the jaw, trouble swallowing, and asymmetry in the treatment area. It’s important to consult with a qualified practitioner to ensure you’re a good candidate and minimize potential risks.

Kybella Recovery

Recovery from Kybella is typically quick, with most patients experiencing some swelling and discomfort for a few days after the procedure. Swelling is often a sign that the treatment is working, as the fat cells are being broken down and cleared away. Over-the-counter pain relievers can help manage any discomfort.

Patients should avoid strenuous activities for a few days post-treatment but can resume their normal routine shortly after. Results are gradual and may take a few weeks to become noticeable.

Kybella FAQs

How much is Kybella?

Kybella cost can vary depending on the number of treatments needed and the geographic location of the provider. It’s best to consult with your provider for a personalized quote.

what is kybella used for

What is Kybella best for?

Kybella is best for reducing submental fat under the chin. Commonly known as having a double chin, this neck and chin fat can make many patients feel self-conscious.

Furthermore, it’s ideal for people who have excess fat under their chin but want to avoid invasive surgical procedures like chin liposuction.

Will I need multiple treatments of Kybella?

The number of Kybella sessions needed varies based on the amount of fat under the chin and the desired results. Most patients require at least two treatment sessions, spaced about a month apart.

In some cases, more sessions may be recommended for optimal results, but this depends on individual factors like the amount of submental fat and the patient’s aesthetic goals overall.

Schedule a Consultation to Discuss Kybella Treatment

Kybella treatment can completely change your facial profile without surgical intervention. Please get in touch today to schedule a one-on-one consultation appointment with board-certified plastic surgeon Dr. David Sieber to find out more.

Dr. Sieber and his experienced team can help you learn if Kybella would be right for you.

References

  1. https://www.mykybella.com/what-is-kybella

Breastfeeding With Implants

Many women who either currently have breast implants or are considering them have the same question:

Will I still be able to breastfeed my baby with breast implants?

Below, we will attempt to answer this question and several other related concerns we often hear from new and soon-to-be mothers.

Can a Mother With Implants Breastfeed Her Baby?

Yes, breastfeeding is certainly possible when a mother has implants. There are some caveats, however. In some cases, for example, implants may limit a mother’s ability to produce milk. While some breast milk may be produced, she might have difficulty producing enough breast milk to adequately support her baby. Keep in mind this challenge (under-producing milk) can happen to any mother, no matter whether she has implants or not.

Factors Influencing Milk Supply in Mothers With Implants

There are three main factors that may contribute to a mother’s milk production ability when she has implants:

  • The amount of glandular tissue present. Glandular tissue is the tissue that actually produces breast milk. It can sometimes be lost during breast implant surgery, or some women simply don’t have a lot of it to begin with.
  • The amount of scarring in and around the milk ducts.
  • The amount of overall breast tissue and nerve damage that occurred during breast surgery (often impacted most by the type of breast implant surgery performed).

We will discuss these and other factors in more depth below.

What’s important to note here is that most new mothers experience at least some challenges breastfeeding their baby — especially when it’s their first child. Things like how to best position the baby, what a good latch looks like, how often to feed the baby, and how to pump effectively all influence a mother’s ability to be successful at breastfeeding.

Key Concerns When Breastfeeding With Implants

1. Incision Location

It matters where on your body incisions were made for your breast implant surgery. Potentially, the most damaging location is around each areola. This area of the breast is crucial for the let-down reflex, which ultimately releases breast milk for the baby. When breast augmentation surgery occurs here, it is possible there will be a reduction in nipple stimulation, and nerves may be damaged.

breastfeeding with breast implants

2. Type of Surgery

Where your incisions are located largely depends on the surgical technique used by your doctor. Again, around the nipple surgical techniques tend to produce the biggest issues for breastfeeding mothers. In the armpit techniques and beneath the breast techniques often yield better results, with more nerves and glandular tissue left intact.

3. Implant Size and Positioning

In most cases, it is better to have implants placed under the layers of muscle in the breasts. Otherwise, when implants are placed over the muscle layers and between the muscle and glandular tissue, this can cause more issues. Similarly, larger implants often exert more pressure on the glandular tissue.

Both of these issues can cause breast milk-producing complications similar to engorgement.

4. Engorgement and Mastitis Issues

It’s important that a mother’s milk is able to drain well out of her breasts. However, breast implants may inhibit this process, which can lead to common breast-feeding issues such as engorgement and mastitis.

Engorgement occurs when the breasts are full or over full of milk, and draining is a problem. Engorgement usually happens during the first few months after a baby is born when the mother is still regulating how much breast milk she needs to produce. Engorgement makes it difficult to breastfeed, and it can be painful as well.

Mastitis occurs when the breast tissue is inflamed and results in an infection. This can also be painful and may lead to further medical complications.

5. Other Possible Complications

Finally, it’s important to remember that some women may experience complications during their breast implant surgery or complications after surgery that require revision or repair procedures. These can further complicate a woman’s breastfeeding success and may lead to additional damage of the glandular tissue, nerves, and milk ducts.

Are There Any Risks When Breastfeeding With Implants?

According to multiple resources, including the Centers for Disease Control and Prevention (CDC), “There have been no recent reports of clinical problems in infants of mothers with silicone implants.” At the same time, the CDC and other medical agencies bring up the fact that little research has been conducted on the safety of breastfeeding with implants.

risks of breastfeeding with implants

Silicone Safety

While it is never an intention to allow silicone to enter a baby’s milk supply, it’s also important to remember that silicone (the primary material used to make most breast implants) is, as the Department of Obstetrics and Gynecology at the University of Michigan mentions, “widely present in the environment and silicone drops are commonly used to treat infants for stomach gas, or colic.”

What is of primary concern when it comes to breastfeeding newborns is that the baby is getting an adequate supply of milk. Even if a mother cannot produce enough milk to fully supply her baby with nourishment, she may still choose to provide what breastmilk she can and supplement with formula. Doing this is perfectly fine, and it is much better than attempting to supply your baby with entirely your own breastmilk when you’re having difficulty producing or latching your baby. This can cause serious health concerns for newborns, who will not be getting the nutrients they need to grow and thrive.

Frequently Asked Questions

Do breast implants make breastfeeding more difficult?

Breastfeeding with implants is usually not more difficult, but it can depend on the placement of the implants and the surgical technique used. If the milk ducts or nerves were affected during surgery, milk production could be reduced. However, many women with implants can breastfeed successfully.

Is it safe to breastfeed with implants?

Yes, it’s generally safe to breastfeed with implants or after a breast augmentation surgery. The materials used in breast implants, such as silicone or saline, do not pose a risk to the baby, and breastfeeding can often be done without issues. However, it’s important to discuss with your surgeon if any specific concerns apply to your case.

Can breast reduction affect breast milk production?

In the case of breast reduction, the surgery can affect milk production. The procedure may remove glandular tissue or impact milk ducts, potentially reducing breast milk supply. However, many women are still able to breastfeed successfully after breast reduction surgery, though outcomes vary depending on the surgical technique used.

Do You Have Other Questions About Breastfeeding After Implants?

As stated above, we often get questions from mothers concerning breastfeeding and cosmetic breast implants. If you are considering breast implants, or breast augmentation but aren’t sure if it’s right for you because you plan on becoming pregnant at some point after your surgery, we welcome you to book an appointment with Sieber Plastic Surgery today to discuss your options. Dr. Sieber would be happy to speak with you about any questions you may have and help clear up any concerns.

References

 

Dr. Dave Sieber and his staff are so awesome! Dr. Sieber is personable yet professional, his work is impeccable. He listens to his patient and works with them to achieve what they want. He’s like my hair dresser, a magician, you just want to do a happy dance with the results, only these results are lasting. Ok, but seriously, the procedure was very smooth, the staff and the doctors (Dr Sieber and the anesthesiologist) had great communication and made sure I was comfortable with very clear and concise pre op and post op directions. The healing process was very easy and the results are FABULOUS. Side note, Dr. Sieber has really awesome skin, I feel like this is impressive and important because really, would you trust a dentist with bad teeth? I am so elated and satisfied with the results, the size is perfect and they look and feel very natural. They are exactly what I wanted.*

SF Scientist

Dr. Sieber is a doctor who is not only extremely knowledgeable about the latest in cosmetic procedures, but a doctor who truly cares about his patients. I highly recommend him!*

christinemv

Dr. Sieber is a doctor who is not only extremely knowledgeable about the latest in cosmetic procedures, but a doctor who truly cares about his patients. I highly recommend him!*

jamiee

Dr. Sieber is attentive, responsive, and well trained. I had seen him for Botox and filler and he had done both without any pain or bruising and more importantly the results were fabulous. He has met with me on time at each appointment. He communicates what to expect, made sure I was comfortable throughout the procedure, checked on my healing every day post procedure. He couldn’t be more delightful not more talented. I had seen other plastic surgeons for in office treatments over the past decade and Dr. Sieber is at the top of the list in terms of delivering the desired outcome and high quality care.*

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