Do I need a chin implant and lipo or a kybella (belkyra) and dermal fillers? (photos)

Thanks for your question and photos. There are a few options available that could potentially treat fat under the chin and define facial features. Non invasive solutions include Kybella and laser treatments, which in my opinion have less than optimal results. Surgical option would be liposculpture of the areas of concern and complimenting that with a chin implant for a more defined jaw line and profile. Alternatively, liposuction combined with skilled fat transfer along the actual jawline to make it more pronounced including the chin is a good option especially in mild to moderate situations. Best to get an in-person consultation with a board certified plastic surgeon to discuss individual procedures that suit you.

Thanks for sharing. In general, current neck rejuvenation procedures include:
A NECK LIFT* with a LOWER FACELIFT would be the gold standard and gets the best results usually reserved for patients about mid to late 40's and older. You also get jawline improvements.A NECK LIFT* stand alone would be the next best procedure and tightens only the neck.CHIN LIPO and/or LASER LIPOLYSIS if only fat removal is required with good skin elasticity, typically in a younger patient. A Platysmaplasty can be added for further muscle tighteningPROFOUND RF, FaceTite, and ULTHERAPY are FDA approved minimally invasive tightening technologies using using radio frequency or ultrasound energies. KYBELLA injections for a double that melts fat under the chin and takes a few sessionsBOTOX to the platysma bands to decrease their show*It is important the a Neck lift involves some liposuction and importantly a platysmaplasty which is a procedure that tightens the underlying loose neck muscles. 
Based on your photo and being younger, chin lipo and chin augmentation I feel would be ideal.   I usually perform these procedures under local anesthesia and oral sedation comfortably with natural results.  Ultimately it is best to be examined and consulted in person. Talk to several board certified plastic / facial plasrtsic surgeons .

Dear aimaim,Kybella typically takes 3 to 5 treatments to work. This is why I've stopped carrying Kybella in my office.  I recommend neck liposuction more often then any injectable procedure for the neck now. It provides superior results gives me more control over the area than any injectable.  It also costs about the same as what you paid for your first kybella session. The liposuction can be done under local while awake in the office and recovery is about the same as kybella.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You have a few options to improve the projection and symmetry of your chin and profile. If you’re not sure you’re ready for surgery, but still want to improve and strengthen your chin, I’d suggest augmenting your chin with Sculptra and/or Voluma. If you like your new look, you can make it permanent with a chin implant. Neck liposuction is a great option for patients with good skin elasticity and excess fat in the neck and around the jawline. This will remove excess fat and stimulate the skin to contract over time which will improve angulation and definition along the jawline. I recommend seeing an expert for a consultation who can go over this procedure to determine if it will achieve your desired results and the cost of the procedure. I hope this helps!

    The side profile photograph demonstrates a weak and recessive chin profile for which a chin implant can improve. A chin implant can augment the chin forward to help facial balance, proportions, and  give better structural soft-tissue support to the structures in the neck. The fatty deposits in the neck can be removed with liposuction. Both procedures are complementary to each other, and can be performed under local  anesthesia to save on costs. For many examples of this combination, please see the link and the video below 

 Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  From the photos, your chin is very weak as are the back portions of the jaw line and there is a slight amount of excess fat and skin under the chin.  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.   In contrast, removing the small amount of fat, under the chin alone, by any method will not produce a meaningful aesthetic result because no forward projection would be added to correct the weak chin.
 In my opinion and experience there is no need to secure a silastic chin implants with sutures and screws when the following conditions are met:
 * Select a silastic chin implant ( I prefer the EAC) that doesn't have too much projection (thickness) as this becomes a problem stabilizing the implant under the periosteum when the implant is too thick.
 * Place the implant through a small curved incision under the chin which allows direct access to the periosteum (under the mentalis muscle) while preserving the muscle attachments.  This prevents upward migration of the implant which can occur when the intra-oral approach is used that severs the muscle attachments.
 * While the center or body of the chin implant should be placed at a perpendicular angle the chin bone in order to provide the proper forward projection to the chin, the "wings" of the implant should be at a lower level and follow the inferior (bottom) edge of the jaw line on either side of the chin.  When properly dissected and placed, this will be below the mental nerve foramen and be just wide enough of a dissection to accommodate the tapering wing.  There isn't enough room in this technique to allow the wings to migrate upward and contact the mental nerve.  In contrast if the dissection, along the sides of the chin (jaw line) are performed too high...this will place the mental nerve in danger and if the side dissection is too wide, the wings will have a space within which to migrate upward.
 * We have all of our chin implant patients avoid touching and feeling their chin implant for 1 month post op.  We also ask that they sleep on a U-shaped airline pillow for the same time.
  Our experience when following the technique described above is that the silastic chin implant does not need to be secured with sutures or screws and does not move.  I have placed silastic chin implants in military, SWAT, LE, professional fighters, as well as actors and many regular people who are active.  In addition, I have had the opportunity on numerous occasions to replace silastic chin implants (placed by others) that had been screwed into the bone.  During the replacement it was evident that the metal screws pushed right through the soft silastic implant as it was tightened down on the hard chin bone.  Which makes perfect sense.  So in the long run, these fixation methods alone are no guarantee that the implant won't move.  Proper placement, proper implant pocket creation and meticulous closure of all the tissues layers is what is required in my humble opinion.
I prefer placement of a  silastic chin implant through a small, curved incision under the chin (submental) instead of through the mouth for the following reasons:
*The submental approach is sterile while the intra-oral approach is not.
*The submental approach requires limited dissection as it is much closer to where the chin implant needs to be placed along the center (front) and lower most sections of the chin on each side (where the wings are placed).  The intra-oral approach by contrast requires dissection all the way down the entire section of the chin in order to reach the same areas for chin implant placement.  This leads to several issues in my humble opinion.  The attachment of the chin muscle to the bone must be cut during the tissue dissection, the sensory nerves (mental) and motor nerves (marginal mandibular nerve) that move the muscles of the lips and mouth) are all in much greater jeopardy of injury because of the added dissection required.
*The added areas of dissection with the intra oral approach allows upward migration of the implant as well as an increased risk of nerve injury.  Damage to a sensory nerve will create numbness and or an ache type discomfort while injuring the motor nerve will result in an inability to "lower" the corner of the mouth and lower lip.  
 There are numerous shapes and sizes of silastic chin implants, some of which are rather old shapes that do not yield the desired "natural" aesthetic results.  The Curvilinear shape is an example that is similar to the old "button" implants (had no wings or lateral tapering elements of the newer EAC design) that created a "pharaoh" shaped chin.  The EAC or extended anatomical chin implant style offers, in my experience and humble opinion, the most natural, aesthetic result when augmenting the chin.  The EAC in a size small is the most common implants that I use in women ( size medium in men ).  Proper placement and the appropriate approach (placing the incision under the chin and not inside the mouth) are also key to obtaining the best aesthetic result. Dermal fillers, precisely placed, can also be used to augment the chin and jaw line without masculinizing the face.  Permanent fillers and fat should be avoided due to the unwanted side effects. I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

The focus should always be for the long term and ensure that the underlying bone structure is balanced since that will ensure both a short and longterm correction. To that end, a genioplasty rather than an implant is best since it 'flattens' the area 'under' the chin, whereas an implant does not. This is because the genioplasty lengthens the muscle under the chin whereas implants do not.