How would you fix this chin to remove the excess? (Photo)

This is a fairly common concern and can be addressed surgically or with Botox/Dysport/Xeomin. I usually suggest that we try to treat the area with Botox, Dysport, or Xeomin to see if relaxing the muscle a bit helps correct the concern. We usually only have to use 3-6 units, which is a very small amount. If you like it, the results last about 3 months. If you decide that you would like to try to address the issue surgically, the area is addressed by removing a relatively small amount of the chin musculature. You have some swelling for a few weeks.

It is not excess cartilage but an excessive soft tissue chin pad. You have what is known as a hyper dynamic chin ptosis, int becomes more prominent when smiling and looks normal at rest. A submental approach to used to reduce some of the thickness of the chin pad and a little bone. The challenge in these hyperdynamic cases is that there is no chin deformity at rest so conservative resections are needed to provide improvement in smiling but not adversely affect how the chin looks when not smiling.