5'9, 185lbs, what type of procedure would you suggest I need for more definition between neck & face? (Photos)

Question

Hello, I am 5'9, 185 lbs, still on my weight loss journey. I've had several consultations with mixed feedback. I've been told I need: • chin lipo + jplasma • chin + neck lipo, nothing else • chin lipo + facetite I am also wondering if I would need a mini neck lift to get the look I desire? I want to get rid of that neck skin that connects from my chin, I want a bit more definition between my neck and face. Please also let me know if you'd consider 1 incision vs 3

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy 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. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Lucian Ion, FRCS · Answer

Thank you for your enquiry and sharing your photographs. 
It is somewhat difficult to evaluate whether there is genuine skin excess also but most likely it is minimal or there is no skin excess. 
The majority of the fullness under the chin seems to be a hereditary feature involving deep seated fatty tissue under the chin, which is not accessible to liposuction, the volume of the digastric muscles and the volume of the lower part of the submandibular gland. There is also some prominence of the parotid glands further back close to the earlobes.
Deep plane anterior neck lift off short scar neck lift or isolated neck lift (involves also a small amount of skin tightening) can produce a significant change in the contours of the jawline and neck by reducing fatty tissue volume under the skin and in the deeper layers, reducing the volume of the digastric muscles and volume of the lower part of the submandibular glands.
It may be suitable to do all of this through a 3 cm incision under the chin. 3D imaging and simulation can allow an analysis of the skin surface and determine whether volume reduction needs to be accompanied by a small amount of skin tightening or not.

Sharon Y. Giese, MD · Answer

It looks like you have a good amount of excess neck fat. The chin projection looks good, but there are little notches on the sides of you chin (pre-jowl notches). I would recommend filling them with some of your neck fat.

William Portuese, MD · Answer

The noninvasive treatments you were recommended are not going to be of any benefit for you. It is very important to understand that there are two compartments of fat in the neck, and they are located both above and below the platysma muscle in your neck. From these photographs presented, it appears that most of your fat is located below your platysma muscle, which is going to require a neck lift procedure to surgically extract the fat below the muscle, and also includes a platysma plasty to significantly improve your jawline. Liposuction is also performed, however, liposuction can only remove the fat deposits above the Muscle. You when patients have a recessive chin profile, we also recommend a chin implant when necessary which helps improve the jawline

Mats Hagstrom, MD (license on probation) · Answer

When choosing a procedure, we should generally start the process by first, having a clear understanding of what the problem is.
In your case, there are a lot of different tissue variables that can, and most likely are contributing to what you don’t like.
First and foremost is facial, skeletal structure. Almost 100% of people seeking chin and neck. Liposuction have a small mandible in relationship to their Maxilla.This typically presents with individuals who have an overbite, dental, occlusion, and profile pictures often the upper lip will have more forward projection than the lower lip. Patient will have a lack of jawline definition, a premature double chin, premature jowls, and this type of mandible causes the underlying platysma muscle to drape the neck in a more oblique fashion.
From what you described, you are losing weight but despite this, your jawline isn’t getting improved. That would indicate the subcutaneous fat isn’t creating a problem. 
If you assess the thickness of your subcutaneous fat layer, it’s probably relatively thin and is not the cause of why your jawline and neck look the way they do.
You don’t have a fat distribution problem.
For that reason, Liposuction isn’t addressing the primary problem and he’s like me to leave you pretty disappointed.
You might think loose skin is the problem and so skin tightening is the answer, so which one is better JPlasma or facetite.
I can tell you that they will both leave you disappointed.
Ideal candidate for chin and neck, Liposuction are Young individuals who have excess subcutaneous fat and a relatively strong Mandible. Chin augmentation doesn’t change the size of your mandible at least not the body of the man the bowl or the part where the petitioner muscle origin begin. Chin augmentation only augment the chin, which is the tip of the front of the mandible.
Chin augmentation is a good procedure for people who have a weak chin, but it doesn’t fix the problem of having a smaller mandible with all the issues that come with it explained previously. 
With age, we lose elasticity of our skin and age negatively affect peoples candidacy for quality in Liposuction results. 
At the general guideline, I tend to make the cut off at age 50 per patient being reasonable candidate for Liposuction. This means that people who are over 50 years of age generally should not get liposuction and those approaching the age of 50 should lower expectations substantially.
The best candidate for Liposuction I generally individuals in the 20s and 30s.
I have a feeling that any of the procedures you have listed so far I’m going to leave you disappointed.
I really don’t see the indication for doing a mini facelift on male patients. Mail facelift surgery is much more complex than anybody considering having a facelift that has a facial hair, should be highly discriminating and selective when choosing providers. 
The procedure will change the sideburn, and knowing how to do this in the best manner is critical to getting quality results.
Male facelift surgery are complex and requires finding highly experienced surgeons with a proven track record.
The following are some general guidelines for how to find the best provider, regardless of what procedure you select.
Determine facelift and neck lift is often used interchangeably. A facelift treat the neck and lower 1/3 of the face which are exactly what your concern seem to be.
Do not confuse a facelift with a brow, lift, eyelid, surgery etc. etc.
Here are some thoughts to find the best provider maximizing, high-quality long-term outcomes, and minimizing the chance of a disappointment or worse.
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. 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 have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

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