I am considering whether to have a lower face lift or Kybella injections here in the UK or abroad, advice? (photos)

It is sometimes difficult to determine if a surgical or nonsurgical approach to enhance the neck and sub chin regions.  In general, however, surgical approaches are indicated if there is a significant amount of fat or a significant amount of loose flaccid skin. Freezing the fat can make a minor change and is indicated if one has very elastic skin under the chin and just a small amount of fat. Do remember, freezing does have some side effects including reactive growth of fat for some which can be troublesome. Injections designed to dissolve fat are also relatively simple to undergo but results are small. Often, surgery is the most cost-effective treatment that exhibits the most dramatic change and improvement in this area.

"For a double chin, InMode FaceTite with VASERlipo would give you the best result.

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite for internal tightening
7. Ultherapy and Thermage for external tightening
8. Regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness
9. PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen production

See an expert for a formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer"

The characteristics of the jawline and neck suggested several potential problems with fat freezing or Kybella:

- If the treatment is successful, the jawline is likely to appear worse by comparison with the neck

- Because the neck skin appears relatively soft, Kybella has a relatively high chance of producing Contour irregularities.

A facelift with neck lift intervention to reduce the volume under the chin, lift and reduce the volume in the jowl region and address the skin laxity would be the most balanced approach.