Double Chin is Too Firm to Be Fat. How To Create More Definition?

It sounds as if you might need a limited necklift type of procedure which would include a platysmal tightening procedure. The firmness you are talking about could be related to a deeper type of fat called pre-platysmal fat. You might also benefit from a chin implant to strengthen your neck and jaw line if there is a deficiency there. Anyway, it is hard to say for sure without photographs and I would recommend you have a consultation to gather more information.

For a more defined jawline to strengthen your profile (and help prevent the dreaded jawline "jowl" sagging), we use injectable fillers like Revanesse Versa - a filler known to limit swelling and give subtle, soft enhancements - or Radiesse. Using a cannula to limit pain and swelling, we inject on the bone in strategic points to get more lift and shaping, resulting in a more contoured lower face and defined, structured jawline. I would suggest getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

  It is hard to offer advice without seeing photos and I admire the other doctors who have replied for their efforts to help.  Given the platysmal bands, I agree that neck surgery may be beneficial. even if you do not have fat in your neck.

A double chin can be improved with a neck lift or even a chin implant. It depends on your facial features and the quality of your skin. In many cases as it sounds like with you, excess fat it not the problem and other corrective procedures are more often helpful than simple liposuction to the area.

Neck Lift (Cervicoplasty / Platysmaplasty): restoring elegance to the face

Though it is not technically part of the face, a neck with loose, sagging skin can age the face dramatically. A neck lift is a standard part of most facelift surgeries, as the neck skin is mobilized in continuity with the lower face.

Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck. The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

Cervical / submandibular liposuction

Some individuals have 'sagging' necks primarily due to fat accumulation below the jawbone (mandible). In some cases, liposuction alone can significantly improve the neck appearance. Liposuction is also frequently combined with surgical neck rejuvenation, and in selected cases some direct excision of fat (through a hidden incision below the chin) is performed. The reduction of fat in the area below the jawline and in the anterior neck almost always makes the neck appear longer, and makes the patient's profile appear more elegant or refined.

A defined jaw line can be accomplished with either a neck lift or a lower face/neck lift.  Usually patients over 50 will require a face/neck lift while patients under 50 will require a neck lift.  The determining factor is skin laxity.  Both procedures involve removal of fat above and below the platysmal muscle as well as tightening the platysmal muscle in the front of the neck.  The tightening of the posterior muscle is done when a facelift is performed.  The surgeries are performed as outpatient procedures and usually take 2-3 hours under a general anesthesia for patient safety and comfort.

There are several possibilities for your situation. Some people will genetically accumulate fat under their chin, even if they are lean everywhere else. I have seen this change over time with the fat developing later in life. Without a picture it is hard to say, but it is possible that it is fat that you are seeing under your chin. I have also seen a few very lean patients with a firm double chin that had actually developed a benign tumor (usually made up of more fibrous fat) under their chin. Also, as you get older the platysma muscle will loosen and fall forward giving you the banding you mention. This pulls the skin down, causing even more sagging in the mid-portion of the neck. Regardless of the exact anatomic issues, given the platysmal banding, you will likely need a neck lift to resolve this issue. In a neck lift the platysma muscle is tightened, the excess fat is removed, and the skin is lifted upwards. The incisions are hidden behind the ear and under the chin. The results are typically very good- giving a nice smooth, well defined jaw line and neck. If you have some congenital weakness to your chin, a chin implant would make the results even better.

Thank you for your question. I think, based on your description, you need a neck lift. The procedure involve removing the neck fat either directly or with liposuction. and tightening of the platysma( neck muscles) in the midline. This would improve you neck contour and give you a sharper neck- cheek definition. If you think the swelling is not fat, then I suggest you see your PCP for other diagnoses.

A photo would be helpful.  Be sure to schedule your consultation with a Board Certified Plastic Surgeon.  The banding you are noticing are called the Platysmal bands.  Those can be surgically brought toghether through a small incision under your chin.  We offer the Vaser Liposuction which works well contouring the jawline and tightening skin. 

A picture would be helpful. Depending on your age and the cause of your double chin, there are several possible treatments including a chin implant or a neck lift to eliminate the bands and the fullness under your chin..