Submental fat pad reduction

Question

I am 62, 140 lbs. All of my life a street artist would draw me with a "jay leno" or witch chin. So, I guess it is the thing about me. I hate it and I hate the crease between my lip and chin. I have had botox on my chin and while I like the effect, it doesn't fix the protruding chin. IT feels like a soft ping pong ball. I have had no fillers on any part of my face. I want to get my nose and chin fixed and then have a deep plane facelift/neck.lift + CO2. What is the kind of procedure that I need?

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.
In general, the combination of deep plane facelift and neck lift is associated with a redistribution of some of the volume of the chin. The contouring that happens under the chin is also helping to smooth out the appearance. It seems that you are making the right decision regarding your treatment to address the contours in the lower face, jawline, and neck.
For the line situated between the lower lip and the chin, also referred to as the labial mental crease, the types of treatments available include:
- injectable filler
- fat transfer
- subcision
Subcision means releasing the underside of the skin from the surrounding tissues to allow for a smoother transition between the lower lip and the chin.

A reduction of the soft tissue volume of the chin is technically possible, but very few surgeons are offering it due to its technical complexity and the possibility that the chin may look uneven after such an intervention.

Anna Chacon, MD, FAAD · Answer

Hi,

Thank you for sharing all the details—it really helps to understand your concerns. From what you describe, the fullness under your chin sounds like a submental fat pad, which is different from the muscle changes you can temporarily address with Botox. Botox can soften dimpling or “witch chin” lines, but it doesn’t reduce actual fat or correct protrusion.

For the protruding soft tissue under your chin and the crease between your lip and chin, a few options are commonly considered:

Submental liposuction or direct fat excision: These remove excess fat under the chin and can improve the contour of the jawline.

Chin implant or genioplasty: If the chin itself is recessed or you want more projection, a chin implant or surgical adjustment can reshape it.

Neck and facelift (deep plane): As you mentioned, a deep plane facelift with neck lift can tighten skin, reposition tissue, and refine jawline contour.

Combining these procedures can provide harmonized facial proportions—for example, addressing the chin and submental fat first, then doing a facelift/neck lift to refine and lift the overall lower face. CO₂ laser resurfacing is excellent for skin texture and tightening post-surgery but doesn’t affect underlying contour.

Essentially, the approach would be surgical for structural changes (fat reduction and chin reshaping) with adjunctive treatments for skin quality. Your description suggests a combination approach would likely give the most natural and lasting improvement.

Mats Hagstrom, MD (license on probation) · Answer

The prominence of your chin is fundamentally based on skeletal bone structure.
You have a slight lack of projection or flatness of your maxilla with more prominence of the mentalis region(chin) of your mandible. 
There’s really no procedure other than it in reduction that’s going to make your chin smaller.
It shin reduction procedure has a soft tissue and skeletal component.
These are more commonly done by oral surgeons, but plastic surgeons may have experience doing them as well.
It’s not a particularly common procedure and finding someone who has sufficient experience and skilled with the procedure would be very important before contemplating having a chin reduction.
Augmentation of your midface, creating some projection in this area will help balance your face as well, and this should be considered when you have your future facial operation.
Mid face projection, it can be accomplished with a number of treatments.
I suggest you have multiple consultations with both oral surgeons and plastic surgeons in your community to get a better assessment and better understanding of treatment options as well as starting the vetting process of the right provider.
Best,
Mats Hagstrom MD

Submental fat pad reduction

Answers (3)

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