Chin lipo or neck lift after 40 pound weight loss? (Photos included)

Question

I saw a well known for chin lipo/plastic surgeon in person for a consult last week who said chin lipo, $3500 no need for other interventions. Then I did a complimentary consult of some pictures at different angles with a well known plastic surgeon and his consult (w a 35k facelift. What are your thoughts? The dr I consulted in person has a lot of people who recommend him for chin lipo, even people in this group. I’m def not inclined to a 35k procedure but don’t want to spend $3500 if it’s not going to help. Would love your thoughts! For reference, I’m 40. Edit to add: I’ve lost 40lbs over the last year or so (200ish to 160ish). For info, it was a slower weight loss without meds (absolutely NO shade to meds, they’re important health tools! But helpful to know it wasn’t a rapid weight loss that can come with the meds.) I’m feeling great about my weight loss, but want this part of me to match the rest which is looking and feeling strong!

Carl Truesdale, MD · Answer

Weight loss of that magnitude almost always changes what your neck needs.
Chin lipo (submental liposuction) works on fat. It's an excellent tool for patients with a tight skin envelope and isolated submental fullness. When the skin shrinks well after fat removal, the result is a sharp, defined neckline.
After 40 pounds of weight loss, two things usually happen that make pure liposuction a poor choice. First, the skin envelope is loose because it stretched out at the higher weight and doesn't have the elasticity to retract fully after fat removal. Second, platysmal muscle bands often become more visible as overlying fat declines, and fat removal makes that worse, not better.
What typically gives a better result in your situation is a neck lift with platysmaplasty. This addresses both the loose skin and the platysmal bands. The skin envelope is reduced, the platysma muscle is reapproximated in the midline, and the overall contour is sharpened. Recovery is longer than lipo (10 to 14 days for most social activity) but the result is comprehensive and durable.
If you also have jowling from the weight loss, you might benefit from a lower facelift component, which extends the neck lift incision into the lateral facelift incision and addresses the lower face at the same time.
The surgeon who recommended chin lipo isn't necessarily wrong, but I'd ask them specifically how they assessed your skin elasticity. The classic pinch test (lift the skin under the chin and watch how fast it snaps back) is informative. If the skin moves but doesn't snap back quickly, liposuction alone will disappoint.
Get a second opinion from a facelift surgeon before committing to lipo. The two procedures have very different outcomes in post-weight-loss anatomy.

Mehmet Ozdemir, MD · Answer

First of all, congratulations on your 40lb weight loss that is a massive achievement and it's completely normal to want your profile to reflect how strong you feel. Looking at your photos, you are caught in a classic surgical dilemma: while the $3,500 chin liposuction will certainly remove the remaining fat, it does not address the skin laxity or the underlying platysmal bands (the neck muscles) that have become more visible after your weight loss. If you choose liposuction alone, there is a significant risk that the skin won't "snap back" perfectly, potentially leaving you with a slightly deflated or crepey appearance. However, a $35k full facelift feels like an extreme jump for someone your age with your specific goals. A middle-ground approach, such as a neck lift or a deep-plane neck lift with platysmaplasty , would likely give you the crisp, defined jawline you’re after by tightening both the muscle and the skin, offering a much more predictable result than lipo alone without the full scale (or cost) of a total facelift.

Anna Chacon, MD, FAAD · Answer

First of all, congratulations on your weight loss. Losing 40 pounds gradually through lifestyle changes is a huge accomplishment, and it’s very common for the face and neck to be the areas that lag behind in “catching up” after major body changes. A lot of patients describe exactly what you did — feeling healthier and stronger overall, but noticing lingering fullness or looseness under the chin that no longer matches the rest of their progress.

Based on your description, I can understand why you received two very different opinions. In cosmetic medicine, this often comes down to what problem is actually being treated:

Excess fat responds best to liposuction
Loose skin and muscle laxity respond better to lifting procedures

At age 40 after significant weight loss, many patients actually have a combination of both.

If the main issue is still a pocket of localized fat with relatively good skin elasticity, chin lipo alone can absolutely create a cleaner jawline and more definition. This is why you’re seeing strong recommendations for surgeons who specialize in it — in the right candidate, the improvement can be very satisfying without a major surgery or long recovery.

However, if there is already noticeable skin laxity, banding, or a “heavier” appearance caused more by loose tissue than fat, liposuction alone may only partially improve things. In some people, removing fat without tightening the skin can actually make laxity more noticeable afterward. That’s usually why another surgeon may recommend a more extensive neck lift or facelift approach.

That said, a $35,000 facelift recommendation does not automatically mean it is the only correct option. There is often a large middle ground between:

minimally invasive chin lipo
and
a full facelift/neck lift surgery.

For example, some patients do very well with:

chin lipo plus skin tightening
a mini neck lift
platysma tightening
or a conservative lower-face procedure rather than a full facelift.

One thing I’d encourage patients to think about is their goal. If your goal is meaningful improvement and better contouring, chin lipo may accomplish that beautifully. If your goal is a perfectly tight, sharply sculpted neck with maximal correction of skin laxity, then a lifting procedure may be more appropriate.

The reassuring part is that gradual weight loss like yours often leaves the skin in better condition than rapid weight loss does, so your tissue quality may still respond reasonably well to less invasive approaches.

Most importantly, trust the surgeon’s ability to explain why they are recommending a procedure. A thoughtful consultation should clearly describe:

how much of the issue is fat versus skin
what improvement is realistically expected
and what limitations each option has.

A conservative approach is often reasonable when someone is hesitant to jump into a major surgery, especially if expectations are realistic.

Rachelle Eljazzar, MD · Answer

It is rare for me to recommend submental liposuction on patients who are older than their 20s. In my opinion, removing fat without addressing the skin or platysma (and other potential contributing anatomy assessed in person) will just result in a loose, aged neck. There is a limit to the amount of fat that can be safely removed without actually making the neck look worse. That being said, you could certainly have some improvement with conservative submental liposuction, but I would agree that for the optimal outcome a face and neck lift would be the best option.

Daniel Barrett, MD · Answer

Dear Neat780794,

it is hard to tell for sure without an examination. 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

Yily De Los Santos, MD · Answer

At 40, especially after weight loss, it’s very common for the neck area to have a combination of fat and some skin laxity. That’s why you received such different opinions.

Chin liposuction works very well when the main issue is fat and the skin still has good elasticity. If there’s mild laxity, it can improve things, but it may not fully define the contour.

A facelift is recommended when there is more significant skin and tissue laxity. It’s a more comprehensive procedure, but not always necessary.

There’s also a middle ground, which is quite common: patients who benefit from liposuction, sometimes combined with treatments to help skin tightening, without needing a full facelift.

The most important difference here is that an in-person evaluation is always more accurate than an assessment based only on photos. Skin quality is not fully appreciated in images.

If the surgeon who examined you in person has strong results in cases similar to yours, that opinion usually carries more weight. It’s helpful to review before-and-after photos of patients your age with weight loss and understand how your skin is expected to respond.

Vikesh Vij, MD · Answer

First of all congratulations on your weight loss journey. In my opinion, based on the pictures, having the lax skin in the neck addressed via just a neck lift or neck and face via a facelift and neck lift would be the best option . Since there is skin laxity, a liposuction of neck area will not address the skin . It might make it worse. I would recommend you go with the 2nd surgeon and have it addressed it the right way.

Mats Hagstrom, MD (license on probation) · Answer

The primary reason you don’t have a definition along your jawline and a double chin is because you’re mandible is undersized in relationship to your maxilla.
The problem is not related to fat distribution, but rather bone structure pride. Paragraph creating a bigger mandible is not easier or straightforward so people often turn to soft tissue solutions for a problem that is fundamentally based on bone structure.
 Weight loss patient typically don’t need liposuction.
Weight loss, patience typically have more of a skin issue rather than excess subcutaneous fat.
For that reason, Liposuction is likely to not give you a significant improvement.
The number of plastic surgeons were truly exceptional at Chin and neck liposuction is really small.
Most plastic surgeons are not good at Liposuction. 
If I left is probably a better option.
Augmentation to your mandible should also be considered.
Consider consulting with oral surgeons for a proper assessment regarding the bone structure of the lower 1/3 of your face.
Best,
Mats Hagstrom MD

Chin lipo or neck lift after 40 pound weight loss? (Photos included)

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