Choosing the correct procedure should be based on a clear understanding of what the underlying problem or ideology is. The primary reason for most individual peoples facial aesthetics is based on bon structure, not soft tissue coverage. Your mandible is small and lacking in projection compared to your maxilla, and this is the primary reason for forming a double chin. This also typically presents with a dental occlusion overbite. Pictures will show the upper lip having more forward projection than the lower lip. patients have a premature double chin, jowls, and loss of jawline definition. Fullness in the dorsocervical fat pad region responds well to Liposuction, but often spinal contour contributes as well. Delivering consistent quality liposuction results is more difficult than most people realize. The number of plastic surgeons who truly mastered Liposuction is in the minority. In regards to treatment options. There are a long list of treatment options available. Liposuction is a simplistic way of looking at the problem but offers Relatively easy procedure with some potential improvements. It will not resolve all the issues since fat distribution is not abnormal. Your fat distribution is normal though obese. To treat the primary problems would require addressing bone structure, which is the underlying cause for the platysma muscle draping the neck in an oblique fashion. This together with excess subcutaneous fat, creates your unique facial appearance. To get an assessment regarding facial bone structure consider consultation with oral surgeons or plastic surgeons with craniofacial fellowship training. A neck lift will address skin and platysma muscle, as well as subcutaneous fat. It is a more comprehensive and definitive treatment, then Liposuction alone. Liposuctiona is the easiest procedure, but doesn’t treat the underlying problem. Liposuction results very dramatically based on who you choose as your provider if you opt for that treatment option. Simply getting an accurate assessment for this part of the face is complex and you’re likely to get a host of different opinions from various providers. This can be confusing and frustrating for patients, but the area in inherently complex. Both patients and providers often look for easier alternatives. Typically soft tissue manipulation, which while potentially beneficial isn’t addressing the underlying cause. Buccal fat removal can cause problems later in life when facial volume is a premium, creating potential, premature hollowing and aging. Easiest healthiest, cheapest, safest, and best recommendation would be weight loss. Changing the primary shape of your face is more complex than most people recognize. Obesity can be tackled without medical intervention, and should be the first option for people who are overweight. To get an accurate assessment, and to find the best provider, I suggest patients have multiple in person consultations with local board-certified plastic surgeons and or oral surgeons in your community. During each consultation, ask each provider to show you their entire collection of before and after pictures of previous patients, who had similar facial characteristics to your own. Learn to recognize facial shape, including the relationship between your mandible in Maxilla. An experienced provider should have no difficulty showing you the before, and after pictures of at least 50 previous patients. There is significant variation in competence when it comes to Liposuction. Being board-certified in plastic surgery with years of experience, and a good reputation does not mean somebody has mastered any one single procedures, such as Liposuction. Liposuction is a permanent and irreversible operation. If done, poorly results are very difficult to improve upon and patient can be left disfigured. Patients should be more selective then they think necessarily when it comes to finding a liposuction providers. Acceptance of genetic heritage and taking control of your own physical and emotional health through diet and exercise. As well, creating a healthy mind should be the first step in looking and feeling better about yourself. Best, Mats Hagstrom, MD