What would be the best solution for this area under my chin? Kybella? Lipo? Facelift? (Photo)

I am 46 years old, and have this terrible area under my chin. I just can't seem to do anything to make it go away. I have a little lipo in that area. I've tried thermi, thermage, and all those crazy devices. If there isn't anything I can do, I would appreciate the honesty there as well.

Doctor Answers 12

Your remaining options to address your neck are limited at this point

At 46 you are in a very distinct group of people that have emerged since the dawn of more minimally invasive or non-invasive anti-aging treatments.  You are at the threshold of the earliest changes of facial aging, yet you really don't need, and probably don't want, the more traditional, aggressive rejuvenation therapies of years past, like full face and neck lift, which until relatively recently were all we had to offer.  Thus, until relatively recently, people in this group you are in were either over-treated, or they simply were sent away and told to come back when things were "bad enough" for them to actually have a procedure.  Now that we have a plethora of treatments designed to be milder, less invasive, and less risky, we are finding that your demographic is now at the forefront of facial rejuvenation efforts - in fact, more treatments and procedures are being designed and focused for "you" than for the more traditional facial rejuvenation population.  Having said that, it serves us all well to be aware of the assortment of treatments available and to really understand, in great detail, what each of those treatments is designed to do, and what its limitations and risks are.  Patient selection is key, and one of the most important things in all of this is to select the right treatment for the right patient.  These treatments are not all interchangeable, and if you use one of them inappropriately, for an indication it is not best used for, you can make things much worse.  This is especially prone to occur with brand new technologies as everyone is either so enthusiastic about offering the newest and latest, or they are not yet experienced enough with it to fully comprehend its limitations and risks.  One of those treatments which I think falls into this category is Kybella.  While it may well be a great treatment for a specific indication, it must be fully understood what it is designed to do, and the patients to whom it is offered must be very carefully selected.  I just responded to an unfortunate lady on RealSelf about 2 weeks ago who had Kybella injected under her chin, not once but twice, even though she developed a deformity after the first injection.  Unfortunately, it was not noted that the first Kybella injection had dissolved too much of the fat below her chin exposing her loose platysma, and she had a second injection.  Then she was told that she had "loose skin" under her chin, and they sold her a package of expensive and painful "skin tightening" treatments, which predictably did not correct the problem either.  Now she is left with unsightly platysma bands from loose platysma muscle beneath her chin and a much lighter wallet!  The same has happened with CoolSculpting below the chin too.  This is not the kind of sitation we all hope for.  I tell you this because I want to stress the importance of your doing your homework in finding the right doctor to evaluate your face and then recommend the right treatments.  From the pictures you have posted, and from your history of having both liposuction under your chin and tightening treatments including the topically applied Thermage and the subcutaneously (under the skin) applied Thermi RF, I think that things like Kybella or more liposuction under your chin are the WORST things you could do at this point.  At best, they don't address what I believe is the real issue, and at worst, they can create a bigger problem for you.  If you had a big bulky fat pad beneath your chin, maybe Kybella would work, but you don't - it was already removed with the liposuction you had.  Now you appear to have loose platysma mucles - a very thin sheet-like muscle which drapes across the front of our neck and up over our jawline and becomes loose with age and sags, causing jowls and loose bulges beneath our chin.  Like the previous lady I discussed too, this must be distinguished from "loose skin," because the treatments for those can be vastly different.  Based upon what I can see of your case, it appears as though you have mild early platysmal laxity, and while it is very mild, and you could very easily not do anything at all about it and be just fine, if you are to consider doing something, you will most likely need something  surgical to address your loose platysma, like a facelift procedure.  This can most likely be a "mini" or short scar facelift, but it will need to be something that can reliably and effectivley tighten the platysma muscle directly; and that is a surgical procedure.  Topical treatments, like laser or Thermage, won't penetrate to the proper depth, and any fat reducing treament, like Kybella, CoolSculpting, or liposuction, is very likely to make things worse, because the problem is not fat.  My best advice is to consult with surgeons, like board certified plastic surgeons or facial plastic surgeons, who are familiar with not only minimally invasive and non-invasive treatments for facial aging, but also a variety of surgical options.  They are the only ones who are specifically trained in all treatments, including surgery, of this area, and they will know best the anatomy and be able to correctly diagnose the problem.  They will also be best equipped and trained to recommend the right solution for you, and this is the best way to avoid future problems and complications from unsatisfactory results.  Best of luck.

Chin/neck solution

Thank you for your photos. It is best to have an in-office examination to determine what anatomical structures are causing the appearance of your chin/neck area. If you have had liposuction already, then it is possible that rather than excess fat, you have excess skin which is the biggest culprit. Unfortunately, Kybella and more lipo will not help remove loose baggy skin. Loose skin needs to be removed with a necklift. A necklift will remove excess skin and fat and can also allow the plastic surgeon to tighten the neck muscles if necessary to improve your contour. Hope this helps!


Johnson C. Lee, MD Plastic Surgery

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 12 reviews

Neck Lift

Thank you for your question and for posting appropriate pictures. I'm sorry to hear that you are not finding results with these other treatments. I would recommend undergoing a neck lift in order to pick up that loose skin and give you a more aesthetic jawline. Make sure that you're working with a board certified plastic surgeon with expertise in this area. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.8 out of 5 stars 88 reviews

Kybella

Thank you for your question. The ideal candidate for Kybella is anyone over the age of 18 who is unhappy with the appearance of double chin. Successful patients will be in good health and understand the Kybella treatment plan. Kybella can provide dramatic sculpting results for the double chin. I suggest that you move forward and consult with a board certified facial plastic surgeon.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 96 reviews

Neck Appearance after Liposuction

Thanks for your question and photos.  While it is difficult to be sure without an in person exam, it is likely that the changes you see in the neck area are due to normal aging and post-lipo skin and muscle loosening rather than from residual fat.  The great challenge with subtle findings like these in the neck area is that the solution is surgical skin tightening which may simply be too aggressive for where you are at this time.  There are so many non-invasive treatments available today, but as you have learned first hand, the results are not often consistent with the cost involved. Consult with a board certified plastic surgeon to fully evaluate your needs and discuss the tradeoffs involved in your treatment options.  The likely recommendation will be surgery to address the loose skin and muscle, and ultimately it will be up to you to decide if that treatment is worth it to you at this time.  Best of luck.

Facelift

Thank you for the question and providing photos. It appears to be more of a problem with extra skin rather than excess fat. Unfortunately, Kybella and chin liposuction will not improve your neckline if there is truly excess skin. Some minimally invasive skin tightening procedures are helpful, but you will probably get the best result with a face and neck lift. This will also eliminate some of the jowling that can be seen in your photos. I would recommend getting several opinions. Good luck.  

Kybella for submental fat under chin

Hello Missannf,

Thank you for posting your photos. Kybella is a great option to eliminate submental fat under the chin. You may need a series of treatments, usually 2-4 and require between 2-3 vials at each visit. Schedule a in office consultation to discuss the best treatment plan to achieve your desired goal. Best to you, Dr Faraz

Kybella can not treat excess skin

Without assessing you in person, it is impossible to give you any truly accurate advice but the fact that you've already had liposuction in this area leads me to believe that the issue is probably one of excess skin as opposed to fat. And excess skin is not treatable with Kybella. In fact, there really are no solutions for it other than surgery. My best advice would be for you to schedule a consultation with a board certified plastic surgeon in your area to discuss your options. 

Kindly,

Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 reviews

What would be the best solution for this area under my chin? Kybella? Lipo? Facelift? (Photo)

Thank you for sharing your question and photographs.  Based on your pictures alone it appears that you have prominence of the muscles along your chin region with some chin skin laxity and excess.  In my opinion the only option at correction would be a formal surgical neck lift procedure.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Kybella treatment for submental fat

Thank you for the photos but without a hands-on evaluation it is unclear if the troublesome area is secondary to fat. It sounds like you have tried several procedures without a satisfying result.  If this is being caused by fat (or residual fat after your liposuction) it should respond well to Kybella.  Kybella injections will destroy the fat cells but the first step is to see medical professional to confirm that the situation is caused by fat.  Good luck.

Dr. Berdy

Jack Berdy, MD
New York Physician
4.8 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.