I had a double chin for years. I have had CoolSculpting, Kybella (2x), and Fotona and not much of a difference. Options?

"For a double chin, InMode FaceTite with VASERlipo would give you the best result.

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite for internal tightening
7. Ultherapy and Thermage for external tightening
8. Regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness
9. PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen production

See an expert for a formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer"

Thank you for your pictures. For the pictures you send is my impression that you need surgery to correct your neck. Kybella only works in the fat and CoolShaping also works in the fat no in the skin or muscles

The procedures that you have had thus far have only contributed to the issue you were seeking relief from in the first place. There is likely very little fat left in the submental compartment and what is left is laxity in the platysmal muscle and skin of the neck. There are several laser available that will modestly improve this laxity, there are also suture procedures that will temporarily improve this area with little downtime, but if you want a long lasting and natural result then a neck left with platysma muscle tightening is going to be necessary.