I am tired of having a double chin and chin lipo didn't work. What's next? (photo)

Question

I am tired of having a double chin. I have tried chin lipo which is supposed to be the gold standard treatment, but it didn't work. I tried 3 rounds of Kybella a year after chin lipo. Now a year after Kybella, I tried Ultherapy. This is now months after Ultherapy and I still have a double chin. I can't tell if this is a dental issue, I need another round of lipo, a chin implant, or a neck lift. I just want to get rid of the double chin.

Cory Bovenzi, MD · Answer

Hi, and thanks for the question!
I would recommend a deep neck lift at this point, since it should definitively treat this area. Especially after kybella, liposuction can be less effective and predictable. None of these techniques besides the necklift address the fat under the platysma muscle which should be done in your case. I wish you the best!

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

Jason Emer, MD · Answer

"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

Daniel Barrett, MD · Answer

Dear Bab27,
it is hard to tell for sure without an examination. Based on your photo, it looks like you would benefit from chin lipo. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gurkan Kayabasoglu, MD · Answer

Unfortunately, especially in patients with a very fatty neck like you, the two methods you have tried are already very ineffective. Therefore, you need to have surgery with a special technique called submentoplasty. You can also book an online consultation and discuss your problems with me. With all respect.

Dilip D. Madnani, MD, FACS · Answer

From your pictures, you would benefit from an in person evaluation. Sometimes there is fat underneath the neck muscles, platysma muscle, that cannot be treated with neck liposuction or kybella, and would need to be surgically removed. So a neck lift would be the best option. Another beneficial procedure for you would be to get some chin projection, either with a chin implant or chin fillers.

Its hard to determine exactly based on one picture, as you have already tried some treatments without improvement.

Its hard to determine exactly based on one picture, as you have already tried some treatments without improvement.

Jeffrey Lisiecki, MD · Answer

You should be seen in person to be evaluated and discuss your options. Your chin looks a little small based on your photos, so any option to help treat this region will include some form of chin augmentation. I wouldn't expect kybella and ultherapy to do much (they are usually underwhelming in my experience). Chin lipo works great, but it is dependent on the technique and skill of the surgeon, as well as the aftercare (especially how long did you wear a compression strap for). You also probably need some form of skin tightening with chin lipo (such as Facetite). Finally, if it is not the subcutaneous fat that is the problem but it is deeper neck structures, you might need some form of a neck lift procedure to address this, which would be diagnosed by an examination in person.

Mats Hagstrom, MD (license on probation) · Answer

Your procedures continue to fail because you don’t have a fat distribution issue. That was never the problem in the first place and that’s why fat removal hasn’t worked for you.
The most important aspect to cosmetic surgery is getting an accurate assessment in other words you have to make the correct diagnosis. whether told by others or you simply assumed it on your own but fat is not what’s causing your double chin.
Most people have very consistent soft tissue coverings of their facial skeleton and it is facial bone structure that determines do unique appearance of each persons face and this includes the chin and neck area.
You have retrognathia or an under developed small mandible. Most likely you also have a dental overbite occlusion, on profile pictures your upper lip have significantly more forward projection than the lower lip you developed a double chin regardless of what weight and other young age, lack of jawline definition and premature jowls. individuals with a long projecting mandible have none of these because of how the platysma muscle directs the neck first going horizontally then taking a straight turn down the neck creating a defined jaw line. when the origin of the platysma muscle starts just in front of the neck the muscle never gets a chance to start off in a horizontal plane but goes obliquely across the neck. that is your double chin and the reason for it.
Most likely a jaw advancement is a much better procedure but to get a formal assessment and better understanding of cranial facial surgery I suggest consulting with oral surgeons or board-certified plastic surgeons who have fellowship training and actively practice craniofacial surgery.
Your problem is not a soft tissue one so soft tissue solutions while they can give a partial improvement aren’t treating the problem.
Consult with a few oral surgeons in your community and see what they have to say.
Best,
Mats Hagstrom MD

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