I am only 26. Is this a double chin or sagging skin after weight loss? (Photo)

Thank you for your inquiry and for sharing your photographs.

The images suggest predominantly digastric muscle fullness and a small amount of central fatty tissue under the chin, situated deep in the platysma. This would not be influenced by the Botox treatment to the submandibular glands, which appear relatively small. The parotid glands are not oversized, and the fullness that you see laterally when you bring the chin down is purely due to the superficial soft tissue layer.

In the submental region, the volume that you see on neck flexion is an increased projection of the floor of the mouth, pushing the digastric muscles and central fatty tissue down. You can also note that there is a slight increase in the prominence around the submandibular glands, but it is not very visible.

Liposuction under the chin has relatively little to offer in your situation. A small amount of liposuction along the jawline can be carried out and produces a sharper appearance along the area as the skin elasticity will work with the liposuction. If you want to address the volume of the digastric muscles and deeper seated central fatty tissue, an anterior neck lift procedure can potentially help. It does, however, a 3 cm incision and therefore a scar under the chin for access.

The lower face / neck contours are relatively good, so no intervention is also a sensible alternative.

Ultherapy is a non-invasive procedure that lifts the neck, chin and brow, and improves lines and wrinkles on the upper chest. As we age, collagen breaks down, resulting in loss of skin strength and elasticity. For tissue tightening, Ultherapy is ideal for the lower face and neck and we often combine it with CO2 laser or Morpheus8 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.

Best,
Dr. Karamanoukian
Realself100 Surgeon

You are young and there is some mild amount of fullness under the chin. This is more likely to be fat rather than the platysma which is an issue in older patients. The liposuction helps reduce the fat. There are some other treatments such as the Facetite that also help achieve some skin tightening.