Which procedure option is best to help minimize the appearance of a double chin / weak jaw line? 21 y/o (photos)

Question

I have been told that my double chin is more due to loose skin than fat. I am 21 at a normal weight between 115-120lbs. It does not go away when I lose weight. I am interested in jawline filler but am unsure if this is the best option for me.

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

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Jeffrey H. Spiegel, MD · Answer

We could improve this, in the office, very likely with a medium sized chin implant and some skin tightening.  Recovery time is minimal though there is a period of swelling from the chin implant.

Daniel Barrett, MD · Answer

Dear kxbtov,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

William Portuese, MD · Answer

The Side profile photographs demonstrate a recessive mandible and weak chin profile. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions. The procedure can be performed under local anesthesia as an outpatient procedure which takes approximately 30 minutes.

Darryl J. Blinski, MD · Answer

Based on the nicely posted photos I would offer under chin lipo or so form of lipo with heat generated skin treatments plus HA or fat grafting to complete jawline. Fees from $6,000+ Best to virtual consult with....

Mats Hagstrom, MD (license on probation) · Answer

Making an assessment for the lower 1/3 of the face is complex and beyond what most people are capable of doing.
In reality almost all Aesthetic issues in this area especially related to young people is purely based on bone structure.
The shape of the facial skeleton determines how the soft tissues drape and this is what determines the final overall contours and dimensions.
Soft tissue coverage of the bone tends to be very consistent from person to person. It’s very rare someone has a true abnormal fat distribution on their chin face or neck. likewise the thickness of glands and muscles tend to be very similar from patient to patient.
The attachments for origin and insertion of the muscles varies greatly because those are dependent on the shape of the bone structure.
21-year-olds as a general rule do not have issues with skin laxity. The exception would be individuals who have a genetic collagen disorder or those who have been morbidly obese and have successfully lost massive amounts of weight.
Because most issues are related to bone structure people will often give you different explanations none of them which truly makes sense and likewise none of the treatments really work particularly well either.
Treatments that are consistently effective are always based on treating the primary problem.
When the problem is bone structure correct treatments become beyond what people want to consider.
It is simply too scary or invasive and people look for a softer gentler solution but in the end doesn’t work.
Even making an assessment on demand a ball itself can be difficult.
If you look at your own pictures it doesn’t initially appear that you have a weak or small mandible. The reason for that is your chin has forward projection. The forward projection of your chin creates a slight crease or fold below your lower lip. people who don’t have a projection of their chin don’t have that fold and people who have excessive projection have a deep fold there. at the same time on your profile picture your upper lip has more forward projection than your lower lip and this tells me you have a dental overbite occlusion. Dilip position is directly related to how your upper and lower teeth are related to each other. The lips rest on the teeth so the position of the teeth determine where the lips sit. Most people or those with aesthetic perfect facial structure typically have a lower lip that has more forward projection than the upper lip. 
It’s possible to have a deficient mandible or volume is lacking in the body of the mandible or the part of the bone behind the teeth. at the same time the front of the man the ball or the chin can be projecting quite well. In other words the mandible is both large and small at the same time just in different areas.The lack of projection of the mandible in the back part of the bone creates the overbite occlusion and causes the underlying platysma muscle to drape the neck in the more oblique fashion. This is the definitive answer for why you don’t have the jaw line definition you would like and why are you have a premature developing double chin.
Augmenting demandable will not move the origin of the platysma muscle and will not fix the problem.
Jaw advancement is probably too radical but is the correct approach.Liposuction works well in this area for individuals who are a little chubby or have extra fat to work with.
This is especially true when the procedure is done by someone who has sufficient skill and experience to get consistent quality results.
Delivering consistent quality liposuction results is more difficult than most people believe. The number of providers can do the procedure well on a consistent basis including the ability to make accurate assessments with accurate predictions of results based on showing numerous before and after pictures of similar patients with similar facial characteristics is a small minority of plastic surgeons. 
The best doctors for making quality assessments for this part of the face or probably experienced oral surgeons.
They typically make assessments based on bone structures first and foremost. since that is the foundation of why each persons face looks the way it does it is an excellent place to start when it comes to having a good understanding of why someone’s face looks the way it does. especially if you’re interested in changing it.
A good treatment plan always begins with an accurate diagnosis.
If the treatment does not address the primary problem results will never be great.
There is in fact no easy great treatment for what you describe and what you are hoping to achieve.
That is not to say there’s no room for improvement but to get impressive results will require work that most people probably aren’t willing to undergo.
Regardless of what you decide it is always important to try to find the most talented and experienced provider for whatever procedure someone chooses to have.
Importance of properly vetting providers is absolutely paramount and minimizing dissatisfaction and regret when it comes to cosmetic surgery.
I recommend patients to do that by having multiple in person consultations.
During consultations recognize that it is your responsibility to vet the provider and that requires taking an active role during consultation.
I recommend patient start by bringing in pictures of their own face or body depending on what procedure is being discussed.
As providers to open up their portfolio of before and after pictures and ask them to show you their entire collection.
Providers may be apprehensive to do that and will instead prefer to show you preselected images representing the best results of their career.
This is however insufficient for the patient to get a clear understanding of what average results look like or how many of these procedures that surgeon has actually performed.
I recommend patients insist providers only show them before and after pictures of previous patients who have very similar facial or body characteristics to their owner.
There’s no point in seeing results on individuals who had a completely different candidacy for the procedure since candidacy is one of the major ingredients that determine what outcomes will look like.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as that hope for.
We all have a variety of different types of results and it’s fair game for patients to ask to see a variety of results.
Ask specifically what does surgeons revision rate and revision policy is.
For reference an experienced surgeon should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures.
Highly experienced surgeons will in fact have hundreds or even thousands of before and after pictures for procedures done on a regular basis. obviously younger surgeons with less experience one that have the same number of before and after pictures.
Both skill and experience are vital to mastering how to do any one single procedure.
Look very carefully at both the number and quality of before and after pictures and take notes during each consultation.
Tell Sarah good idea and take a note about the overall thoroughness of the consultation regarding other aspects like medical history, physical examination, discussion of alternative procedure, risks and benefits, preparation, recovery etc. etc.
There’s no correct number of consultations patients need to have but the more consultations you have the better the chance you’ll find the best provider. most people don’t have a lot of experience in consulting with plastic surgeons so having more consultations typically will make it better at the process.
Each consultation will give you a new chance and hearing a new providers assessment including treatment recommendations.
You can be validating to hear talented providers consistently recommend the same approach just like it can be frustrating and bewildering if each provider has a different recommendation.
When different providers have different recommendations it often implies that there is no one single best treatment solution.
This may be the case with you if you have multiple consultations with plastic surgeons in your community.
I generally recommend avoiding virtual consultations whenever possible.
I don’t believe patients can properly vet plastic surgeons with a virtual consultation and surgeons certainly cannot make as good of an assessment without a proper examination.
I’m not sure if this answered any of your questions or was that it is what came to mind based on what you posted. 
Good luck,
Mats Hagstrom MD

Which procedure option is best to help minimize the appearance of a double chin / weak jaw line? 21 y/o (photos)

Answers (7)

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