I have double chin where the second chin is a hard mass. Is surgery the only option? (Photo)

Question

The mass is not like a lump, but feels more like a muscle. Have you seen this before and is surgery an only option? I did an echo and I have nothing, not even fat, just muscle. I've always had it since I was a child.

Matthew Schulman, MD · Answer

Sometimes the neck muscles can be large and can give the appearance of a lump or bulge. Liposuction can sometimes make them appear worse. If it really bothers you, you can seek out a facial plastic surgeon and see if you would benefit from partial resection of these enlarged muscles.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Jacob Tower, MD · Answer

Hello, hope you are well. The muscles under the chin that can cause that type of fullness are called the digastrics. I would be curious to see the ultrasound, but if the interpretation is correct, the only way to reliably reduce the digastric muscles is with surgery. It is more likely that a combination of deep fat and muscle contouring is necessary via a short scar neck lift. (Despite what the ultrasound report may say, everyone has some amount of fat between the skin and muscles of the neck). An in-person consultation and physical examination would help guide you to the best treatment.
Best,Dr. Tower

Anna Chacon, MD, FAAD · Answer

Your condition sounds like it could be a form of submental fullness, commonly referred to as a 'double chin', which can be caused by a variety of factors including genetics, weight gain, and aging. However, it's unusual that you describe the additional mass as hard and muscle-like, and that it has been present since childhood.While fat is the most common cause of a double chin, other possibilities can include salivary gland disorders, lymph node enlargement, thyroid disease, or even certain types of tumors. However, since you've mentioned that an ultrasound didn't reveal any abnormalities, these are likely not the cause.In some rare cases, hypertrophy or enlargement of the platysma muscle, which extends from the collar bone to the jaw, could potentially cause a physical appearance similar to a double chin.Surgery is indeed one option for treating a double chin, regardless of the cause. However, it's not the only option. Non-surgical treatments like CoolSculpting, Kybella injections, or radiofrequency treatments can also help to reduce the appearance of a double chin, though these are typically more effective for fat reduction than for treating muscle.
As always, it's important to remember that any medical or surgical treatment carries potential risks and should only be undertaken under the guidance of a qualified healthcare provider.

Darryl J. Blinski, MD · Answer

Based on the posted photos I recommend sub chin ultrasound examination to see if fat , muscle, both, a thyroglossal cyst?? Then see in person a boarded head & neck surgeon, ENT, plastic surgeon.

Mats Hagstrom, MD (license on probation) · Answer

Aesthetic appearance of the lower 1/3 of the face is primarily determined by bone structure of the mandible. This is true for all aspects of facial aesthetics, but your concern is the lower 1/3 and the bone that determines the contour and shape of this area is the mandible.
Soft tissues tend to be very consistent from person to person and what determines each person’s individual facial appearance is based on bone structure. The bone structure determines how the underlying soft tissues drape the neck and give the appearance. The ultimate appearance is a combination of soft tissue and bone structure but the variation from one person to another is more determined by bone structure then it is soft tissues. Read your logic. Examination isn’t going to show anything because your soft tissues are normal.
You can open any anatomy book and find out all the anatomic structures on this part of the face. Generally, it’s skin, subcutaneous-fat, submandibular, salivary glands, platysma muscle, then the deep muscles of the neck.
Manipulating the bone structure may be a bit complex and you don’t have a significant fat layer to manipulate with Liposuction.
Sometimes accepting our genetic make up and recognizing that this is what we were given in life, rather than looking to change, or appearance is more appropriate.
Surgical intervention is appropriate when somebody is a good candidate for surgery.
Some situations are easier to correct that others.
We can certainly have consultations with plastic surgeons in your community. I’m guessing a lot of them may recommend Liposuction.
Liposuction may or may not be a useful procedure, depending on how much fat there is to remove in the area.
Oral surgeons tend to be more focused and bone structure while plastic surgeons can’t be more soft tissue oriented.
Alternatively, you can also consult with oral surgeons who can’t do more mandibular surgery.
Avoid surgical intervention without having a clear understanding of what the problem is for seeing numerous before and after pictures by providers recommending any procedure.
Sometimes surgery is warranted and sometimes it’s not. This depends on your candidacy for surgical intervention, as well as how motivated you are to have this area manipulated.
Vertical lengthening of your chin with a sliding genioplasty, may potentially improve the appearance. Your chin has fairly good forward projection, but it’s a little lacking in a vertical height. The body of your mandible is probably somewhat short and I’m guessing you have a significant dental overbite occlusion.
Unless there’s a clear indication for having surgery, patients should stay on the conservative side. 
Best,
Mats Hagstrom, MD

I have double chin where the second chin is a hard mass. Is surgery the only option? (Photo)

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