Thank you for your question
From this picture, it looks like the jowls aren't the problem. It is the underchin that is full, possibly a family tendency, as you are just 32. So a few recommendation, which are just recommendations and not a substitute for a consultation. The first part of the problem is excess fat in the underchin, and simply put Ultherapy doesn't bust fat, not at all. So your choices become
1) Kybella, an FDA cleared series of injections to dissolve fat, not to the jowl, but the underchin.
2) ThermiTightitm a newer and I believe more precise way to both remove fat and tighten skin.
Laser lipo, Lipo/Lift, aren't standard procedures but a local marketing brand. Yes, you are right there is some risk, although small but still real, injury to nerves in treating jowl over the jawline, so choose your doctor wisely.
A surprise, and what's more important, there are easy miles to gain with using injectable fillers, such as Juvederm Ultra Plus, with building up the downward turning mouth crease folds (nasolbial folds) and its lower extention, (prejowl sulcus, that is the grooved hollow, just in front of the jowl) and you could build up the chin.
The truth is you need both the right use of fillers, and a wise choice for fat removal for your best result.
Contouring chin and jowls
An in-person consultation is necessary to evaluate your condition and find the best treatment options that will achieve your goals. That said, in general, Kybella is a good choice for reducing fat underneath the chin non-invasively, but it will not tighten the skin. Chin lipo also will reduce fat under the chin; the downtime will be longer but more dramatic results can be achieved in one session. If you are concerned about skin laxity, Ultherapy or ThermiRF may be better choices. These procedures can both be used to tighten loose skin around the neck and jaw, reducing turkey neck and jowls. It may be possible that both a fat reduction and a skin tightening procedure will be needed for you to achieve the chin and jaw contour that you want. I recommend visiting a board-certified dermatologist with expertise in skin tightening and fat reduction procedures for a consultation and evaluation.
Chin and Jowls and Best Treatment
Thank you for posting your photos. First, I would recommend injecting a filler into the chin such as Juvederm to fill in this area. Then I would recommend a combination of Kybella and Thermage for skin tightening of the neck and jowls. Please consult a board certified dermatologist with years of experience with cosmetic injections. Best, Dr. Green
Chin implant and neck lift
There are 2 compartments of fat in the neck, above and below the platysma muscle. To rejuvenate the neck and remove both components of fat, a neck lift is required. This involves removal of sub-mental and sub-platysmal fat in addition to a platysma-plasty. At 32 years of age, skin tightening is probably not required. A small Silastic chin implant would also bring the chin forward to complement the new jawline. For many examples and more information, please see the link and the video below
Which would you recommend; Kybella, Ultherapy, or chin Lipo/lift?
Thank you for your question. Best option would be liposuction or kybella. Good candidates for kybella are also good candidates for liposuction. Patients with good skin tone and mild to moderate fullnesswill have good results. You can liposuction jowls very conservatively. A chin implant would also help improve your profile. Consult with board certified plastic surgeon to discuss the best option for you.
Kybella vs Coolmini vs Liposuction- and maybe a chin implant too
Fantastic question! Good to know all of your options.
There are multiple factors that go into answering this question...
If there is a lot of fat, liposuction is your best bet. This can be done in-office under local anesthesia.
If surgery is not something you are comfortable with, Coolsculpting would be your best bet financially... as long as the Coolsculpting applicator fits and you are okay with more time to see full results (than liposuction). If your jaw is too small or the amount of fat too little, the CoolMini may not fit.
Lastly, if you have a small amount of fat and the CoolMini applicator doesn't fit your face, I would go with Kybella. There is a significant recovery period with Kybella and the product is not cheap. That is why I reserve it for people with a small amount of submental fat.
All three will give you some skin tightening.
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Which would you recommend; Kybella, Ultherapy, or Chin Lipo/Lift?
Kybella (injectable deoxycholate). It has a fabulous ability to sculpt that area, with little downtime, only transient, relatively mild side effects, and nearly no serious long-term adverse side effects. Having done deoxycholate injections into fat for TEN YEARS, treating hundreds, I have never had a single patient who was dissatisfied or unhappy with the results to their neck. The results are truly permanent fat reduction and significant skin-tightening. It is important to choose your physician injector wisely, as it is a very technique-dependent procedure.
In Europe, it has even been injected into blood vessels for fat emboli (fat clots), without any significant adverse effects on the vessel walls---it just dissolves fat!
Very safe procedure in the right hands. And without all the many possible risks (not to mention downtime) with a surgical procedure that involves a scalpel.
Kybella / Ulthera treatment
Thank you for your question and sharing your photo. I would recommend starting with Kybella to decrease the sub mental fullness. You should also see a mild degree of tightening with this treatment. I would follow this with Ulthera if you still have concerns about the laxity of the neck or simply plan on both as Ulthera will help you reduce the rate at which the neck continues to develop laxity with time.
Reducing a double chin and strengthening a weak chin
The combination you describe is very common. A full consultation evaluating your full face (not just the lower portion) would be necessary to give a complete answer. For example, many patients' jowls are a results of volume loss in the mid and upper face causing the skin to hang. If that is the case, well placed filler in those areas is the place to start for a natural appearance. Filler to create an elegant and defined jawline from the ear to the chin works well. My personal preference for that area is Radiesse: I find it lets me create a very sharp clean line. For the area under the chin, a lot depends on whether that is actually fat. If the bulge can fit into a CoolMini template, then CoolSculpting is an option. If not, injectable Kybella can be used to dissolve the fat and tighten the area. If it isn't fat, then a tightening procedure like ultherapy could be useful.
For patients who don't want surgery (a neck lift and lipo), the combination of using a filler, fat dissolver and tightener as I described may be a noninvasive alternative.
I hope this answer was helpful.
Kybella treatment fat and jowls
Kybella has been approved for use on the double chin not the jowls.
Although lip weakness caused by liposuction of the jowls is not unusual it is almost always temporary.
Liposuction results are more dramatic with less down time (swelling and soreness) than a series of 3-5 Kybella injections.
Please use this information when consulting in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.