Loose, saggy skin under chin, 42 year old female. What are my best options? (photos)

Question

Looking for the best course of action for this loose, saggy skin under my chin.

Jed H. Horowitz, MD, FACS · Answer

It is best to begin by consulting with a board-certified surgeon in-person. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine if you are a #candidate for #rejuvenating the neck. Chin deficiency with the neck and jawline are also taken into consideration. A weak #chin implies a lack of chin support for the skin along the neck line. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results.
Although, you are trying to avoid a facelift, you may benefit best from  one. Patients who desire facial rejuvenation that is affordable, quick, and effective should also consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™.
A board certified plastic surgeon should evaluate both your anatomical features and aesthetic goals to suggest which procedure best suits your needs. In some cases there may be more than one option to choose from. If you are not a candidate at the time of your #consultation, your board surgeon can recommend non-surgical alternatives to address your concern.

Corey S. Maas, MD · Answer

The best option to get the best result would be surgical. A neck lift with or without face lift would redrape the loose skin in the neck. Additionally, the vertical bands that appear on your neck when you grimace appear to be plastysmal banding, which can also be addressed with a neck/face lift. The loss of collagen in our skin can result in the thin, crepy skin that we all experience, and fractional laser treatment at lower settings can help stimulate regrowth of healthy collagen, thus tightening the skin and soft tissues of the neck. Another option is Ultherapy for skin tightening. This device uses ultrasound technology to treat the tissue under the skin in order to stimulate skin tightening. Discussing these surgical and non-surgical options with a specialist would be recommended to determine your best course of action. Best of of luck.

Kimberly Butterwick, MD · Answer

If you’d like to avoid surgery but still improve the quality of your neck skin, ThermiTight combined with chin liposuction is probably your best option. We call this combination ThermiSculpture at our center and our patients have been thrilled with their results. 
Liposuction removes the excess fat under the chin. The ThermiTight probe is inserted into the same incision used for the lipo. ThermiTight uses radiofrequency (RF) energy to tighten the skin, creating a nonsurgical lift. 
Both liposculpture and ThermiTight take skill to perform well. ThermiTight demands that the physician monitor the temperature both underneath and on the surface of the skin and liposculpture is an art that takes years to master, so choose your doctor carefully.
It will take about 6 months for your skin to tighten, but the effects should last about 7 years Please find an expert board-certified dermatologist who can offer you ThermiSculpture to rejuvenate your neck.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about skin tightening.  As we age, our skin looses collagen and elasticity.  There are several treatment options to reverse this.  The surgical option would be a neck lift.  A nonsurgical option would be Exilis laser treatment or Micro-needling with Platelet rich Plasma, PRP.   Both options would stimulate new collagen production to aid in skin tightening.  To be sure which option is best for you, see two or more experienced, board-certified Plastic Surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.
 
 I hope this helps.

William Portuese, MD · Answer

In our practice, a lower face and neck lift accomplishes tightening loose facial and neck skin, tightening loose facial neck muscles, lifting the jowls, and remove the  fatty deposits underneath the neck, if present.  It is important to look at the issues at hand, not at your chronological age. For many before and after examples, please see the link and the video below

David Hartman, MD, FACS (license suspended) · Answer

Hi.  Many of us are concerned about how the looseness of the neck skin contributes to the appearance of aging.  Minimally invasive treatments, including RF micro-needling, Fractional CO2 laser resurfacing, and Precision SmartLipo, can all be effective to greater or lesser extents in the right candidates.  In your particular case, I would be more inclined to recommend a traditional face lift or at least a mini lift to artfully re-position soft tissue from the jowls back to the upper cheeks and to clean up the looseness of the neck.  Minimally invasive treatments can be value-added at package pricing to further improve skin quality and tightness.

Richard Galitz, MD, FACS (in memoriam) · Answer

There is only one smart choice for sagging skin around the jawbone ( jowls ) and neck. "A facelift." You need the proper elevation and re-draping of the facial and neck skin so as to recreate a more youthful look and still look NATURAL. I do all my facelifts with oral sedation and local anesthesia injections safely, easily and comfortably. This removes all the anesthesia risk and nausea. There is also much less bleeding and so there is much less black and blue and swelling in the recovery period. The procedure takes about 90 minutes, and in a week with sutures out, you go to lunch with friends looking fabulous. Do not get caught up in terminalogy like mini, necklift, facelift, S-lift, etc. An experienced and talented surgeon will remove and re-drape just the right amount of skin in all the places it needs to be done regardless of the terminology used.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed facial shaping procedures including many facelifts and neck lifts for over 30 years.  Many of these facelifts have been minimally, invasive SMAS facelifts.  From the photos there is excess skin under the chin, the chin is weak and "jowls" are present in  the lower face.  "Jowls", are described below but their presence plays a part in the proper selection of how the best, aesthetic treat excess skin in the neck.  your cheeks are flat in the front, jowls are present and the chin is weak.  These factors combine to create a rectangular shaped face. 
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess fat and skin removal) to be very safe, quick and highly effective. Removing excess skin under the chin can be combined with the minimally, invasive SMAS facelift described below.  This technique removes some of the excess skin below the chin using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.  This is an extensive surgery taking 4 1/2 to 5 hours of surgical time with large incisions, possible hair loss and months of recovery.
 If you have "jowls” these represent sagging facial tissues that are the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.Hope this helps.

Loose, saggy skin under chin, 42 year old female. What are my best options? (photos)

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