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.

Based on your photos it looks that anything short of good face neck lift will not produce satisfactory result. That is excellent procedure for a healthy patient with predictable long term result. In person consultation with a board certified plastic surgeon with expertise in facial rejuvenation is recommended. Good luck.

Looking at the pictures provided, in my view a classical SMAS face and neck lift with direct fat removal under the chin and platysmaplasty is the best option do you. I would suggest seeing a plastic surgeon that is both accredited and experienced in these procedures. 

Of course I would say this because I am a facelift surgeon but your neck is very heavy. If all the fat is removed it will be left as a saggy empty bag rather than a heavy bag which will not be the look you are going for. Also fat freezing will do nothing for your marionette lines. Surgery is the only answer to rejuvenate a heavy neck and even then, it is not perfect. Apologies but I hope that helps you decide Adam Goodwin

 Hi, I have performed many SMAS facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  The reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance). From the photos: your cheeks have a "mid cheek groove" indicating a lack of underlying bony support that allows tissues to sag towards the nose and mouth; there is some excess fat in front of the cheeks, in the lower face and in the neck; jowls are present; the chin is weak and there is significant fat and loose skin in the neck.  These factors combine to create a wide, rectangularly shaped face. 
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Liposuction can reduce the fat to further shape the cheeks, face and neck.  In contrast, fat reduction alone using Kybella (reduces fat under the chin) or any method will not provide shape to the cheeks or the weak chin.  Facial shaping in combination with fat removal is required.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.  This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, requires placement of drains, possible hair loss and months of recovery.  Hope this helps.