Recommended procedure to reduce or eliminate sub mental chin fat? (Photo)

Question

5ft 9 170lb . 25 bmi more skinny fat . Please see attached pics . Pic 1 - frontal no movement of chin . Pic 2 - move chin down pic 3 - stretch of fat or lose skin pic 4- tilt head forward pic 5- right side shot . Pic 6- left side shot . I have tried non invasive such as cool sculpt and Morpheus 8. Issue resolves at first then comes back in few months . This issue seems completely genetic . What is recommended solution /cost to reduce and/or eliminate submental fat? Thanks !

William Portuese, MD · Answer

These photographs demonstrate several issues going on in your chin and neck. First of all, you have a very recessive mandible bone, therefore you have poor structural support for the soft tissues in the neck. Consider placement of medium sized chin implant to bring your chin forward for better structural support. You also have significant fat deposits located both above and below the platysma muscle in your neck, and the majority of that fat is probably located below the muscle. A surgical neck lift is going to be required to remove those fat deposits which is a combination of liposuction above the muscle and surgical extraction of the fat deposits below the muscle. A platysma plasty is then performed significantly improved the jawline. This procedure usually takes about two hours under general anesthesia as an outpatient.

Mats Hagstrom, MD (license on probation) · Answer

You don’t have an abnormal fat distribution.
The lack of results are in part due to choosing treatments that are relatively ineffective and removing subcutaneous fat, but even with definitive treatments like liposuction , you should not expect great results.
The primary problem is based on facial skeletal bone structure, particularly the size and shape of your mandible and its relationship to the maxilla.
Facial aesthetics are primarily determined by bone structure. A
Soft tissue coverage tends to be fairly consistent from person to person.
Issues related to the lower 1/3 of the face/neck are therefore generally related to issues related to the mandible.Your mandible is slightly lacking and projection both in the body and the mentalities region.
Lack of projection in the body of the mandible will show us having a dental overbite occlusion good
This will also present with the upper lip having more forward projection than the lower lip.
Advancement of the mandible in the body of the bone is fairly involved and requires mandibular advanced vent.
Lack of projection in the mental region of the mandible can be corrected with either a sliding genioplasty or implantation augmentation. The lack of skeletal foundation to support the soft tissues can also be corrected with a proper neck lift a.k.a. facelift.
Attempting to enlarge demandable is fairly complex but is an option that can be considered as well.
This condition is often assessed differently, depending on what type of provider you are communicating with.
Some providers may think it’s a subcutaneous fat issue, some providers will lean more towards skill, laxity, and others like myself will point you skeletal issues as the primary problem. Generally, speaking the most successful treatments or treatments that address the primary problem.
Treatments aimed at soft tissue manipulation for a problem that is primarily based on bone structure are going to give partial improvements at best. 
Expect different providers to have different solutions straight.
I recommend you insist on seeing lots of before and after pictures before spending more money on treatment options.
For a definitive assessment regarding facial bone structure consult with oral surgeons who have advanced cranial facial surgery backgrounds. This can also be done by plastic surgeons who have craniofacial Fellowship training.
Most plastic surgeons tend to be soft tissue oriented and will probably recommend soft tissue solutions.
Oral surgeons tend to be more bone oriented and will therefore be more likely to see the problem based on its true primary origin.
Understanding the inherent primary problem can help patients understand why certain treatment options may only deliver limited results.
Best,
Mats Hagstrom MD

Recommended procedure to reduce or eliminate sub mental chin fat? (Photo)

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Recommended procedure to reduce or eliminate sub mental chin fat? (Photo)

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