Facial aesthetics are primarily determined by facial bone structure. Soft tissue coverage tends to be fairly consistent from personal person and what gives each individual person their own facial characteristics, whether desirable or not is more based on bone structure. Individuals perform a premature double chin with loss of jawline, definition, and premature jowls. tend to have a facial imbalance with mandible that is small or lacking in projection in comparison to their maxilla. Decent individuals will typically have an overbite dental occlusion. On profile pictures often the upper lip will have more forward projection than the lower lip, even though the lower lip tends to be larger than the upper lip. When the mandible doesn’t have sufficient projection, the underlying plate muscle will drape the neck in a more oblique fashion, causing the above stated aesthetic issues. Implant or sliding genioplasty will help individuals hack projection of their chin, but will not move the body of the mandible forward. Treating the primary underlying problem is often seen as to invasive and undesirable so both patients and providers look for easier softer alternatives. Recognize that soft tissue manipulation is at the best. Going to give you partial improvements when it isn’t addressing the primary problem. You are correct in your assessment regarding lack of fat. That should tell you that Liposuction isn’t going to have much of an impact. Well done necklace may or may not be appropriate. I have seen surgeons who can suspend the neck using a permanent suture with good results (until the suture breaks) You’ll probably find that both assessments and treatment options are going to bury from provider to provider. This is often the case when there is no simple, definitive issue or treatment. If you really want to move forward with surgery, then I suggest scheduling multiple in person consultations with providers who seem to have substantial experience doing male Aesthetic surgery. A male neck lift is inherently different than female surgery. During each consultation ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar characteristics to your own. There’s no correct number of consultations needed to find the right provider. The more consultations you have the more likely you are to find the best provider for your needs. I don’t think it’s possible to select providers without in person consultations. When in doubt, slow down and schedule more consultations. no one has to have cosmetic surgery. We can’t really give you a good assessment based unlimited pictures. The lower 1/3 of the face is always judged in context to the rest of the face. Best, Mats Hagstrom, MD