No results from Laser Liposuction due to low Hyoid Bone position? (Photo)

Question

Hey, I'm 23 years old and around 6 months ago I had Laser Liposuction done in Bangkok. They took out 30cc of Fat but unfortunately I couldn't tell any difference, in no stage of the healing process until now. Not even 1%. I'm now concerned that it might be my low hyoid bone position. I can see on the x-ray that it appears that there is still a lot of fat. Was my surgeon not aggressive enough? He said he will be more careful since i have a beard and the laser could damage it.

Anna Chacon, MD, FAAD · Answer

I can understand how frustrating this feels—especially at your age and after going through a procedure expecting a visible change. What you’re describing is actually a very common scenario in the submental (under-chin) area, and it’s not necessarily that something was “done wrong.”

About the amount of fat removed (30 cc)
Thirty cc is a relatively small volume for the submental region. In thinner patients, even small amounts can make a difference—but only if fat is the main cause of fullness. If the underlying anatomy is contributing more than fat, removing 30 cc may not change the contour at all, which fits with what you’re seeing.

The role of the hyoid bone position
A low-set hyoid bone can absolutely limit how much definition is achievable with liposuction or laser lipolysis alone. When the hyoid sits lower:

The neck angle is blunted by anatomy, not fat

Even after fat removal, fullness can remain

X-rays can look like “fat is still there,” when part of what you’re seeing is deeper soft tissue and structural positioning

In these cases, no amount of aggressive fat removal will create a sharp jawline—and being too aggressive can actually cause skin laxity or contour irregularities.

Was your surgeon “not aggressive enough”?
Based on what you shared, your surgeon’s caution makes sense:

Beard hair follicles are vulnerable to heat-based devices

Over-aggressive laser use can cause permanent patchy hair loss or skin injury

Conservative treatment is often chosen deliberately in bearded patients

So this doesn’t sound like negligence—it sounds like an anatomically limited outcome.

Why it may have looked like “no change at all”
In patients with:

Low hyoid bone

Thicker platysma or deeper fat pads

Strong neck musculature

Laser lipo alone often produces minimal to no visible improvement, even with proper technique.

What this means going forward
This is not a failure of healing—and not something you caused. It’s a mismatch between procedure selection and anatomy. Laser liposuction works best when excess fat is the dominant issue. When anatomy drives the contour, results are inherently limited.

Most importantly: your experience is valid, and your concern makes sense. The lack of change you’re noticing is consistent with anatomical limitation rather than something being overlooked or poorly done.

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photographs. The more likely explanation seems to be that the fatty tissue volume under the skin is relatively small, and therefore the liposuction did not produce much visual impact. One of the problems related to the neck contour is the influence of hereditary characteristics. The volume driven by hereditary features is situated deep to the platysma muscles and is not affected by liposuction.

This volume is generally composed of centrally seated fatty tissue, lateral to which is the volume of two muscle bellies (the digastric muscles), and lateral to them, the volume of the lower part of the submandibular glands. The anterior neck lift intervention is a volume reduction technique that can correct both the fatty tissue volume situated under the skin and the volume situated deep to the platysma muscles.

This produces a reduction in the girth of the neck in the upper part and increased definition for the jawline. It requires an incision under the chin, which typically measures 3 cm.

Mats Hagstrom, MD (license on probation) · Answer

Have you followed up with your provider?
Delivering consistent quality Liposuction results is more difficult than most people realize.
The number of plastic surgeons who have mastered this procedure is pretty far and a few between.
Most people seeking Chin and neck Liposuction do not have a fat distribution issue as their main problem.
It’s not excess subcutaneous fat that gives people loss of jawline definition and a double chin.
 People who have these characteristics universally have a mandible that is small compared to their maxilla. 
A profile pictures typically shows the upper lip will almost always have more projection than the lower lip in these individuals.
These individuals universally will have an overbite dental occlusion.
The primary variable and what determines facial aesthetics, especially in young people is bone structure.
It is the facial skeletal structure that gives each unique person their individual appearance, whether it is aesthetically desirable or not so much. 
So the problem was never fat distribution in the first place, and your procedure most likely was insufficient.
People should recognize that soft tissue solutions to problems based on skeletal bone structure are going to give partial improvements at best. If your provider had sufficient skill and experience, they would have known the difference.
Successful treatments are always based on treating the underlying primary problem.
How many before and after pictures of previous patients with similar facial characteristics did your doctor show you before you had surgery?
How many doctors did you consult with before selecting that provider? 
Why did you have your procedure done in Thailand? Perhaps that is home base for you? I generally do not recommend people do not travel for elective surgical procedures. 
Considering how few plastic surgeons are truly exceptional at Liposuction and that fat distribution wasn’t the issue in the first place, your results are probably typical. 
I’m sorry if my response seems a bit blunt and pessimistic.
And the end, each plastic surgeon is responsible for how they present what they can and cannot accomplish.
Surgeons are responsible for surgical outcome and patients are responsible for provider selection.
There’s probably blame to go on both sides for your disappointment. 
Best,
Mats Hagstrom MD

No results from Laser Liposuction due to low Hyoid Bone position? (Photo)

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