Not a candidate for neck lift or lipo. Are there nonsurgical options that target fat and scar tissue in this area? (photos)

Question

Hello, I would like to know what non surgical treatment you can suggest i have on my neck/chin/jawline area to contour it. Ive had liposuction x3 three times now on my chin/jawline Once in 2017, 2020 and 2021. The the fact it still looks "fat" I'm not sure this I's actually "fat" but rather scar tissue from previous surgery or loose skin. I've spoken with surgeons and they've said I'm too young for a neck lift and liposuction would not work

Thomas Wright, MD · Answer

Lissy Thank you for sharing your photos. I can see the areas of concern in the neck / jawline / chin from the photos. You have a slightly recessed chin. That makes full correction difficult without a chin implant. It is likely that you have submandibular glands or other structure under your jawline that need a lift and tightening. The full correction of this would be a neck lift. A compromise partial solution would be non surgical neck lift with MyEllevate. I agree that is unlikely that more liposuction will help. Wishing you the best of health.

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

Nelson Lee Novick, MD · Answer

Of course, photos, which do not permit palpation and manipulation of the skin, are not ideal for assessing and creating a treatment plan, but, from what can be seen, a lack of sufficient chin projection combined with the absence of jawline definition seem to be at the root of the problem. The use of an appropriately robust HA filler to enhance chin projection will not only better harmonize the projections of the chin, lips and nose in profile view, but will likely create a more defined, straighter jawline (which, in turn, will tighten the submental region. The use of an HA filler along the jawline itself can further improve the situation. You would be wise to consult with an experienced, board certified cosmetic dermatology injector. The results are typically seen on the spot and can be accomplished in about a twenty minute treastment session. Best of luck.

Jason Emer, MD · Answer

​A combination of non-surgical options like Kybella, PDO NovaThreads, Ultherapy and Thermage would do well in combination for skin tightening for the neck. VASER Liposuction (with ThermiRF, Renuvion and InMode FaceTite) is a great alternative for contouring and tightening the chin and neck and can be combined with a neck lift at the same time, if you're a candidate. I suggest getting a formal evaluation with a cosmetic dermatologist to develop a long-term treatment plan that works for you. Best, Dr. Emer.​

Robert M. Lowen, MD · Answer

Dear Lissy,
 For your case, I would use MyEllevate.  This is a non-surgical necklift without incisions. It is done similarly to neck liposuction, in that the neck is infiltrated with tumescent local solution.  The skin is then freed from the underlying platysma muscle with undermining with liposuction cannulas and any excess fat is removed. If skin tightening is desired, I add the Precision directional laser under the skin (developed from the Smartlipo/Cellulaze platform).  
   Then using the MyEllevate tools and suture, a suspension suture, that acts as a sling, is placed.
The openings to introduce the suture are made with an instrument that makes just enough of an opening to pass the suture, but not leave a mark or scar.  The bands of the playsma are also cut using the suture like a little pulley under the skin to release the bands at the cervicomental junction.
   When the suture is passed under the jaw, up to the mastoid (behind the ear) and back, it is tightened in the midline.  This brings the neck skin and platysma up under the jaw and improved the chin neck contour. 
   This procedure can be done at a younger age, so if needed, the patient does not have to wait years, until they can justify an incisional neck or facelift.
    Until MyEllevate, non-surgical necklifts consisted of liposuction (if needed) and laser or RF energy applied to the underside of the skin, to get skin contraction. The contraction was not always enough to improve the neck chin angle.  By adding MyEllevate, better results should be obtainable in cases such as yours.

Ryan Welter, MD · Answer

You’ve been through several procedures, and it’s understandable that you’d like to explore non-surgical options to refine and contour your neck and jawline area, especially given the likelihood of residual scar tissue from prior liposuction.

To address your concerns about "fat" versus "scar tissue" versus loose skin, a thorough evaluation is essential. While your situation appears complex, there are effective non-surgical and minimally invasive options that align with your goals:

1. PRP (Platelet-Rich Plasma) Therapy with Microneedling
PRP therapy can improve skin elasticity and texture by stimulating collagen production and enhancing tissue repair. Combined with microneedling, this treatment is particularly effective for mild laxity and residual unevenness caused by scar tissue. It’s a non-invasive, regenerative option with minimal downtime that can help smooth and rejuvenate the skin over time.

2. Low-Intensity Extracorporeal Shock Wave Therapy (LI-ESWT)
LI-ESWT is a cutting-edge, non-invasive treatment designed to improve skin tightness and potentially address fibrosis (scar tissue). By stimulating cellular repair and blood flow, it can soften tissue irregularities and improve overall skin tone in the neck and jawline area.

3. Thread Lifting (PDO Threads)
Thread lifting involves placing absorbable threads under the skin to lift and tighten specific areas, such as the neck and jawline. This procedure is minimally invasive, provides immediate lifting results, and stimulates collagen production over time. It can offer a more defined contour and improve the appearance of lax skin without the need for surgery.

4. Targeted Fat Reduction (if applicable)
If there is any remaining fat contributing to the appearance, Kybella (an injectable treatment) could be considered to target and dissolve fat cells in small areas like the submental (under-chin) zone. However, a proper evaluation is critical to distinguish fat from scar tissue.

5. Ongoing Skin Care Regimen
To maintain and enhance your results, incorporating medical-grade skincare products that promote collagen production and protect the skin from environmental damage is highly recommended. Sunscreen is essential to prevent further laxity caused by UV exposure.

Since you’ve already consulted with surgeons who believe you’re not a candidate for additional liposuction or a neck lift at this stage, combining non-surgical treatments tailored to your unique needs is likely your best option. It’s also crucial to manage expectations and understand that non-surgical methods often require multiple sessions and maintenance for optimal results.

I’d encourage you to schedule a consultation with an experienced provider familiar with these techniques to develop a personalized plan. Each of these options offers the ability to target specific concerns and achieve a more contoured, refined appearance without undergoing surgery.

Camille Cash, MD · Answer

An in person evaluation is best, but you may be a candidate for FaceTite.  This minimally invasive procedure uses RF technology to tighten skin.  No general anesthesia is required.  Results can be enhanced by adding Morpheus8 treatments.  See a provider near you for a consultation.