Is this fat or mainly loose skin under my chin? (Photo)

Question

I got Lipodissolve a few years ago and my jawline looked mostly snatched after it, but 3 years later i have this residual bulge or sag. Im only 30. Is this mainly loose skin or mainly fat, and would a session of Kybella help, or will it just make the skin look looser. I did get hifu 4 weeks ago, and although its early to tell, i feel like it looks worse after the hifu and the bulge is bigger.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It’s understandable to be concerned about the changes in your jawline, especially after investing in treatments like Lipodissolve and HIFU. Given that you’re only 30, it’s important to determine whether the bulge you're experiencing is primarily due to residual fat, loose skin, or a combination of both.

The residual bulge you’re noticing could be due to a few factors. Residual fat from the initial Lipodissolve treatment might still be present, particularly if the fat loss was not uniform or if some fat pockets were more resistant to the treatment. Alternatively, loose skin could be contributing to the bulge, especially if the fat loss was significant and the skin did not fully retract. Since you’re relatively young, skin elasticity should still be good, but significant fat loss can sometimes outpace the skin’s ability to adapt.

Kybella could be a potential option for addressing any remaining fat. Kybella contains deoxycholic acid, which helps dissolve fat cells in the treatment area. If the bulge is primarily due to residual fat, Kybella could help improve the contour of your jawline. However, if the bulge is more related to loose skin, Kybella might not provide the desired result and could potentially exacerbate the appearance of loose skin by further reducing fat volume.

Regarding your recent HIFU treatment, it’s important to remember that results from HIFU can take time to fully manifest. HIFU works by stimulating collagen production to tighten the skin. Early post-treatment changes can sometimes include temporary swelling or changes in the appearance of the area, which may give the impression that the bulge is more pronounced. It’s common for improvements to become more noticeable several months after treatment as collagen builds up and skin tightens.

In summary, if your bulge is mainly due to residual fat, Kybella might help refine the contour. However, if loose skin is the primary issue, Kybella alone might not be sufficient and could make the skin look looser. Considering the mixed results from HIFU, it might be best to wait a bit longer to see the final results before exploring additional treatments.  I hope this helps and best of luck!

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Mats Hagstrom, MD (license on probation) · Answer

Facial aesthetics are primarily due to bone structure, not soft tissue coverage.
This is especially true for young people who don’t show strong evidence of facial aging.
Aesthetic issues on the lower 1/3 of the face are therefore related to the size and shape of the mandible.
When the mandible is small or lacking in projection, the soft tissues don’t have sufficient foundation and start hanging with typical loss of jawline definition, the formation of a double chin and premature jowl formation. To get a quality assessment regarding facial, skeletal structure and treatments that can address this consider consulting with oral surgeons or plastic surgeons who have craniofacial surgery backgrounds.Most plastic surgeons are soft, tissue oriented.
If the chin or mentalis region of the mandible is lacking in projection, then chin augmentation can help slightly.
The problem is further back in the body of the man behind your teeth.
Most likely, you have a significant overbite dental occlusion.
Individuals who have micrognathia tend to also show the upper lip as having more forward projection than the lower lip on profile pictures.
Your fat distribution is not abnormal and liposuction or fat removal when done correctly can give us some improvements. It doesn’t address the primary underlying cause which is a bit more challenging to treat.
By understanding, the underlying primary problem patients can at least understand that soft tissues solutions to facial skeletal problems are going to give partial improvements at best.
Good luck,
Mats Hagstrom MD

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