LARGE diagastic muscle due to TMJ - how can this be improved? (Photos)

Question

30F with lifelong under-chin/submental fullness that becomes much more prominent dynamically when chewing/eating or moving my neck. I have significant TMJ/clenching issues and a lot of chronic neck tension, and I’ve previously seen an osteopath for this because it feels interconnected. I’ve tried: * Masseter Botox * Chin filler * Lemon Bottle/fat dissolving treatment The fat dissolver made no real difference, which makes me think this may be more muscular/anatomical rather than just fat. The area under my chin visibly bulges and tightens when eating and talking. I’m looking for opinions on whether this could be related to: * digastric/suprahyoid muscles * platysma involvement * chin support deficiency * hyoid/neck anatomy * or something structural/TMJ related. Would appreciate honest advice on: * what may actually be causing this * whether non-surgical options could realistically help * and whether this is something surgery would meaningfully improve.

Sinyoung Song, MD · Answer

Hello, this is Dr. Sinyoung Song from Allheart Plastic surgery, Seoul, Korea. I think your intuition may be correct &mdash; **this may not simply be a problem of excess fat.**From the photos, your chin currently appears to have reasonable projection, but you mentioned that you have had chin filler. This can sometimes mask the underlying skeletal anatomy. Without examining you or reviewing imaging, I cannot determine this for certain, but it is possible that your natural chin and/or mandibular framework is relatively small or retruded. This may contribute to the less-defined transition between the lower face, jawline, and neck.There also appears to be some prominence in the submandibular gland area, although this would need to be confirmed by physical examination and, if appropriate, ultrasound.As you suspected, deeper anatomical structures may also be contributing. The position or morphology of the digastric muscles, as well as the position and laxity of the platysma, can influence the contour beneath the chin. In certain anatomies, these structures can contribute to a more “pelican-like” appearance and make the boundary between the jawline and neck look less distinct.This is important because **if the primary problem is structural rather than fatty, repeatedly trying to remove more fat may not solve the underlying problem.**For a true structural problem, meaningful correction may require a surgical approach. Depending on the anatomy, surgical options can include repositioning or plication of the platysma and, in selected cases, addressing the digastric muscles and other deeper structures contributing to the submental contour.However, I would not recommend choosing a procedure based on photographs alone. A proper examination &mdash; ideally together with appropriate imaging such as X-rays and/or ultrasound when indicated &mdash; would allow a much more accurate assessment of your skeletal structure, soft tissues, muscles, and submandibular glands.I hope this gives you at least a useful starting point in understanding why your previous fat-dissolving treatment may not have produced the result you expected.

LARGE diagastic muscle due to TMJ - how can this be improved? (Photos)

Answers (1)

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