Do I need a bichectomy or a lift? Or double chin lipo? Or all? (photos)

Hello, In suggest you a chin implant to improve your chin projection, added to a laser assisted under chin and lower face liposuction. This will improve your jawline contour and a light skin tightening effect over the treated zones.

Your individual facial appearance is purely based on your facial bone structure. you don’t have anything abnormal about the soft tissue covering other than being slightly overweight.
In your case your mandible is small and lacks projection.  this can cause the lower 1/3 of the face and neck to have undesirable characteristics.
In comparison your maxilla is tall.
Soft tissue manipulation can make slight improvements but it is not addressing the fundamental problem at hand.
People with an under developed mandible often have a dental overbite. 
Treatment options include chin implants including the angle of the mandible, sliding genioplasty and augmentation with fillers.
There are more drastic cranial facial surgery options but they are probably not something most people would consider.
Understanding with the primary problem is sometimes helps people accept the limitations for treatments that don’t address the problem.
Chin and neck liposuction often given stellar results especially in those who don’t have skin laxity. even if it doesn’t address the problem it often gives very impressive results.
Sometimes oral surgeons do a better job at making proper cephalometric assessments of this condition and can offer more definitive treatment options.
Plastic surgeons vary in their experience, education and level of comfort doing facial skeletal surgery.Personally I don’t think you should get buccal fat pad reduction. Other providers may be stronger proponents and it could look good but some patients end up paying the price as they age.
Best, 
Mats Hagstrom MD