Neck lift or Sliding Genioplasty? (Photos)

Question

Hello All! Would you clever people recommend: 1. Sub-mental lipo, 2. Neck lift with lipo or 3. Sliding advancement genioplasty with lipo? I'm 38 and not ready for a full facelift but am concerned about the sagging around my jawline and jowls and double chin (one photo is with head down to demonstrate the double chin and sagging). I also have prominent platysma muscles which I have been treating with botox. I will consider sliding genioplasty but do not want a chin implant. Thanks in advance!

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon to determine your candidacy for Kybella, an FDA approved injectable that creates a more defined jawline by eliminating submental fullness due to submental fat.  
Best wishes,

Jed H. Horowitz, MD, FACS · Answer

A board certified plastic surgeon will evaluate both your anatomical features and aesthetic goals to determine which neck lift procedure best suits your individual needs. Factors which are considered during your consultation to determine if you are a #candidate for #rejuvenating the neck include: 
•Visibility and amount of excess fat below the chin and along the neckline.•The presence of banding down the front of the #neck.•The amount of #excess skin and condition of your skin.•Chin Deficiency.•Presence of Prominent Digastric Muscles (a.k.a. submandibular gland fullness).
During the examination the chin will be evaluated along with the neck and jawline.  A weak #chin means there is not adequate chin support for the skin along the neck line. In younger individuals a chin implant alone is usually all that is needed to improve the appearance of the neck. Subsequently, it will also improve the overall balance of the face and can create the illusion of a smaller nose. 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.
If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend non-surgical alternatives to address your concern. Consulting with a board-certified plastic surgeon who specializes in #neck lift procedures is important to ensure you are receiving the best advice, care, and surgical experience possible.

David Tauber, MD · Answer

As we age, the soft tissues of our face loosen and begin to descend. In the mirror, the first signs are loose skin of the face and neck, fullness under the chin, and the formation of small jowls over the jaw line. 
For younger patients who are just beginning to exhibit these signs of aging, a mini face-lift combined with liposuction of the neck can lift the soft tissue back into place and remove the excess saggy skin. This can often be accomplished through a small incision in front of and around the earlobe. Down time is a couple days and full recovery is usually within a couple weeks. A sliding genioplasty will not appreciably change the neck contour or nor will it lift the jowls. See the link below for more information.  Less invasive options to address the fullness under the neck are neck liposuction alone or an injection like Kybella.A detailed examination will help delineate the best surgical option. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.

Prashant Soni, MD · Answer

It is difficult to assess your chin without seeing how it relates to your nose. However, one option you have beside surgery is to use a filler such as radiesse to increase the projection of the chin. This can be done along side other procedures such as neck liposuction or a necklift.  This filler would have to be repeated yearly.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, I think a mini necklift with liposuction would be beneficial for you.  Your chin position itself is adequate and you do not need a sliding genioplasty.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Reza Momeni, MD, FACS · Answer

If your concern is double chin, then sliding genioplasty does not help.   That operation is specifically for changing the shape of the chin.  Additionally, since you have some neck skin laxity, I don't think option #1 will be very fruitful.  On the other hand, option 2 is a good consideration but you are a little young for it in my opinion.  Consider Kybella.  We do a lot of it and it has good results for people in your situation in my opinion, without burning any bridges for future.

William Portuese, MD · Answer

The limited photographs demonstrate a weak and recessive chin profile for which a chin implant can augment and improve.  Placement of a chin implant will bring the mandible forward which will be complementary to the jawline, and also offers a stronger foundation for the soft tissues in the neck.  A neck lift would involve removal of the fatty deposits above and below the platysma muscle and a platysma plasty.  No skin removal is required.  Both procedures can be done at the same time, so anticipate approximately 2 weeks of visible swelling and bruising.    Choose your surgeon very wisely for both of these procedures.  Study your prospective surgeon's before and after  chin implant and neck lift photo gallery  to make sure it is extensive and  they have dealt with this issue many times in the past.

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

I would stay away from a sliding genioplasty as it is a rather traumatic procedure and if not done expertly can look very asymmetric. Your chin does not appear to be the problem here anyhow. You are developing some skin laxity and jowling which begins in the early thirties for many people. A simple preauricular facelift will elevate the jowls and minimal neck laxity and solve the problem. I do this in 30 minutes with oral sedation and local anesthesia in the office operating room. The incision hides nicely along the edge of the ear. If you feel you are too young and not ready for this then I would wait and do nothing, certainly not the genioplasty.

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