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.

You appear to have some excess skin of your neck and you may have some excess fat under your chin as well. You would get the most improvement with a surgical procedure to address these issues. The type of anesthesia used can vary, depending on the patient and the surgeon, so it is possible that a general anesthesia would not be necessary.

A neck lift with a possible facelift combination may be your best choice. A neck lift alone will address the concerns in your neck. A facelift might need consideration for the mild jowls present.

Thank you for sharing your question and photographs and I am sorry the other treatments did not provide you with many improvements. Based on your pictures alone it appears that a more formal neck lift to address any residual fullness and skin laxity would provide the best long-term results. Hope this helps.

None of the procedures your have had could correct neck deformity presented; neck lift is a procedure of choice. However, be very open with your surgeon about treatments you had since every of these "non-surgical treatments" has severe repercussions on anatomy, postoperative swelling and scarring. Good luck.

You have made a vainest effort to avoid surgery through these non-surgical approaches. But this has shown you that a surgical approach is necessary. Whether this is a more limited submentoplasty or a more formal lower necklift can be debated. But either approach is guaranteed to have more substantial improvements then your prior efforts.

Thank you for the question and photos and you appear to be an excellent candidate for a necklift. So go on some complimentary consultations with experts and compare recommendations after a full examination and discussion of desired results and look at photos of similar patients and become fully informed about the desired procedure

Dr Corbin