What can I do to improve my side profile and double chin? (photos)

Question

I am in my 30’s and physically active. Seems as though the volume in my face disappearing. I have had two rhinoplasties& septoplasties and really don’t want another rhinoplasty surgery to improve my side profile. But, I do not like how far my nose projects over my lips and chin. Front view when I smile now I appear to have a double chin. Overall, trying to see what my options are for a more balanced and rejuvenated face. Any suggestions and input are greatly appreciated. Thank you for your time.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Kenneth Hughes, MD · Answer

Hello.
Great question. Thank you for your pictures. Based on your images, it appears you may benefit from a liposuction procedure. Please visit a board certified plastic surgeon for a detailed surgical plan to achieve your desired results.

Kimberly Butterwick, MD · Answer

Thank you for your question. There are a couple of things you could do to improve your profile. The first is to remove the submental fat underneath the chin using liposuction. This procedure is performed using local anesthetic and tiny incisions that allow for the insertion of micro-cannulas to remove the fat pocket. Chin liposuction is a one-and-done treatment that produces full results in a single treatment session. Recovery is just a few days.  A non-invasive fat procedure could also be performed, such as CoolSculpt Mini. Since your problem is small, this may give you a great result.
In addition, you should augment your chin using injectable fillers. By increasing the chin size and improving its shape, you can balance out your facial proportions and create a more aesthetically pleasing profile. Make sure you work with a doctor who is board certified and highly experienced in these treatments to ensure the best possible results.

Andrew T. Lyos, MD, FACS · Answer

Hello and thank-you for your question and photos.
You may consider a chin augmentation to improve your jawline combined with liposuction of the sub mental chin and neck. Liposuction of the chin area alone could give improvement as well. Liposuction can be combined with J-Plasma (Renuvion) Cool Helium Plasma for skin tightening of the chin and neck produces consistently good results for appropriate candidates. I would recommend an in person consultation with a Board Certified Plastic Surgeon.
Best wishes, Andrew Lyos MD, FACS

Jason Emer, MD · Answer

Thank you for your questionFor 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, or Erbium) and microneedling RF (Fractora, Morpheus8, 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, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, 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

Bianca Knoll, MD · Answer

thank you for taking the time to post your case. I understand your hesitation regarding another rhinoplasty, however the projection of your nose is quiet dominant. You may gain a little by reducing the fullness below your chin. But the effects will be subtle. Advancing your chin forward or placing an implant will also have a limited effect. Increasing your chin projection to balance your tip projection can lead to a pronounced mental crease,  which is not desireable -  and may therefore trade one thing for another. A subtle change in your chin projection, will most likely not give you the desired effect. If the goal is to create a more proportionate profile a reduction of your nasal projection would be the method of choice with or without some additonal improvements of your chin region.Best wishesBianca Knoll

Tanveer Janjua, MD · Answer

The best solution is liposuction and thermitight combination done at the same time. It will give you the best chin/neck profile. Also the procedure is quick and has very little down time. Watch the video below.RegardsDr. J

Joshua A. Halpern, MD, PA · Answer

one would need to evaluate your neck to answer your question. Young people tend to have good quality skin so skin tightening typically is not necessary. Liposuction is good for excess fat between the skin and the neck muscle (NM). If there is fat behind the Nm you may be a candidate for a miniscar neck lift (which I helped to pioneer). This fat is removed through an incision under the chin. I hope you find this information useful.

William Portuese, MD · Answer

The limited side photograph demonstrates an overly projecting nose, and an under projecting chin. Consider placement of chin implant to augment the chin forward to help facial balance and proportions from the side profile, especially with respect to the nose. It's possible to augment the chin more forward than it is able to bring the projection the nose backwards. Even if  you performed another rhinoplasty, You'd only bring projection of the nose back a few millimeters.  There does not appear to be much fat in the neck, however limited liposuction may be of some benefit.

Mats Hagstrom, MD (license on probation) · Answer

I understand the apprehension regarding a third rhinoplasty and generally speaking that procedure pens to be more difficult each time you go in.
You do have a lot of nasal projection. Often we look at nasal projection in comparison to projection of the mandible and the mid face. Your midface does not have adequate projection but your mandible is reasonably good.
This is in context to your nose projection.
It may not be something desirable to you but mid cheek volume with cheek implants or fillers might look really good.
check out the work of Dr. David Marbie in San Francisco. He only works with fillers and gets spectacular results. I’m not suggesting coming to San Francisco every six months but it gives you an idea of what can be achieved using fillers only.
For those who have a weak chin action implants often complements a projecting knows very well but I’m not sure it would look good on you. Excessive chin projection is masculine and creates something called a witches deformity in some people.Chin liposuction it’s probably the easiest most straightforward procedure to help your profile.  The amount of potential change is directly related to how thick your subcutaneous fat layer is.small changes have a substantial impact in this area.
All of us appreciate the quality pictures you’ve posted. In a perfect world it would’ve been nice to see you before and after pictures from your rhinoplasty surgery.
Despite someone’s having had previous procedures if nasal projection is the primary problem and treating secondary concerns isn’t going to get an impressive result.
If your rhinoplasty was done in a conservative fashion the fact that you’ve had two already doesn’t change the fact that that is the procedure that you may need. Pictures prior to your rhinoplasties would help us determine how much more of a change nasal surgery could achieve though I think most plastic surgeons would say there’s room for improvement on the nose.
Your situation is complex. I would seek in person consultations from some of that tab board-certified plastic surgeons in your area who focuses on facial aesthetics or particularly on rhinoplasty surgery. I would say you’re looking for providers who have been around the block a few times and have years of experience.
You will probably get a few different opinions. I’m looking forward to seeing what others have to say.
Best, 
Mats Hagstrom MD