Skin? Fat? Glands? Muscle? Underlying structure? What neck/chin treatments would work best for me? (Photos)

Question

What neck/chin treatments would work best for me? I'm 39 yo. Post Partum weight loss over 1 year. I never liked my indelicate jaw and neck and wanted to do something to fix it but wasn’t sure exactly what I disliked or what procedure I should look into. But, prior to baby, another person on the street would say there was nothing obviously wrong that needed fixing. Most of the frog and turkey you now see in pics has appeared in the last 2 years. Lifetime consistent weight and BMI of about 21. Genetically predisposed to very bulky muscles. I will spend what is necessary for the best result. Sending every bad angle I can capture to hopefully give the full picture. I got a Nefertiti lift about 1 month ago and they added another full dose at the follow up 2 weeks ago. Pics are current. Thank you for your consideration!

Mark Beaty, MD · Answer

Thank you for sharing your photos and your detailed question, and congratulations on your postpartum weight loss!

Based on your photos, I think the combination that would likely provide the most significant and comprehensive improvement would be a deep plane facelift with a deep neck lift.

There appears to be laxity of the platysma muscle as well as fullness beneath the muscle. A deep neck lift can address the deeper structures of the neck, including fat beneath the platysma, which cannot be adequately treated with liposuction alone. There also appears to be some degree of skin laxity, which a facelift would help address and tighten.

The Nefertiti lift can be helpful for certain patients, but when there is a combination of deeper neck fullness, platysmal laxity, and skin laxity, a surgical approach can provide a much more comprehensive correction.

Sinyoung Song, MD · Answer

Hello, this is Dr. Sinyoung Song. Based on the photos, your underlying jawline bony structure is actually quite solid. However, there is a significant amount of excess, lax skin. The bulging you noticed&mdash;which likely becomes more pronounced when you engage or tense the area&mdash;could be due to anatomical variations in the digastric muscle, along with a high probability of platysmal midline diastasis (separated neck muscles).
From a surgical approach, the primary objective would be to repair and elevate the platysma muscle&mdash;which acts as a structural hammock under the chin&mdash;by bringing the separated edges back together (platysmal plication) and repositioning it higher toward the jawline. Additionally, trimming and redraping the excess skin may be necessary to achieve a clean contour.
It is also worth noting that variations in the digastric muscle can cause that distinct "frog-like" submental fullness when engaging the neck muscles. Therefore, an in-person clinical evaluation is essential to confirm the exact anatomical breakdown and tailor the precise surgical plan for you.I hope this answer would help you. Thank you.

David Tauber, MD · Answer

Thank you for providing several views. Based on the photographs, there appears to be some fullness beneath the chin, mild skin and platysma laxity, and a chin/jaw relationship that may also contribute to the less-defined jawline. However, photographs cannot reliably determine how much is superficial fat versus platysma muscle, deeper fat, submandibular glands, or underlying skeletal anatomy.

A Nefertiti lift, when it provides improvement, generally has a modest and variable effect on early jowling caused by downward platysmal pull. It is less likely to meaningfully improve central neck or submental fullness and will not remove fat, tighten loose skin, reduce prominent glands, or change chin projection. Since your supplemental treatment was only two weeks ago, I would allow the full effect to settle before judging the result.

Depending on an in-person examination, options might range from targeted submental liposuction or chin enhancement to a limited-incision neck procedure combining liposuction with platysma tightening. If deeper structures or more meaningful skin laxity are contributing, a more comprehensive neck lift may provide a better correction.

At age 39 and a stable weight, the treatment plan should be driven by your individual anatomy rather than any single feature. An examination is necessary to assess skin elasticity, platysmal bands, the superficial and deep fat compartments, gland prominence, chin projection, and hyoid position before making a final recommendation.

William Portuese, MD · Answer

Since you're only 39, you should not need any skin tightening procedures. You have fat deposits located both above and below the platysma muscle, and probably large digastric muscles. It's impossible to tell from these photographs if you're submaxillary glands are enlarged. A surgical neck lift can address fat removal above the muscle with liposuction, surgical extraction of the fat below the plasma muscle, adjusting the digastric muscles as necessary. This can be done with three small access incisions located behind both ears and an underneath the chin. It also appears that you have a recessive chin, so give some consideration to placement of a small chin implant to help with structural support for the soft tissues in the neck.

Zoran Potparic, MD · Answer

Based on these photos it is very likely that mayor cause of your “neck problem “ is a fat deposit on top of the muscles. In my opinion anterior neck lift through a small incision underneath the chin would be the best way to treat this problem and improve jawline. Good luck.

Erhan Guneri, MD · Answer

To achieve a sharp, well-defined jawline and neck angle, a surgical approach addressing each layer is the gold standard:Submental Liposuction: Gently removes stubborn supraplatysmal fat deposits.Platysmaplasty: Plicates and tightens the central platysma muscle bands to construct a solid muscular hammock.Neck Lift: Redrapes and tailors excess skin to cleanly define the cervicomental angle.A physical evaluation or high-resolution profile assessment is essential to confirm whether subplatysmal fat or prominent submandibular glands are contributing to the fullness before finalizing the surgical plan.

Randall O. Craft, MD · Answer

You have asked the right question, because the answer determines the operation. At 39 with a lifelong BMI around 21, skin excess is unlikely to be the main problem. What changes a neck in your situation is submental fat (which weight loss does not always remove), platysma bands and a loose central platysma (your "frog" when you strain), sometimes prominent submandibular glands, and a chin that is slightly short, which makes everything behind it look heavier. A Nefertiti lift addresses only the muscle pull, which is why it moved the needle a little and not a lot. The honest assessment is done by examination: pinching the fat, having you grimace to see the bands, feeling the glands, and measuring chin projection. The surgical answer for a neck like the one you describe is usually a neck lift with platysmaplasty, with or without submental liposuction and a chin implant, done through a small incision under the chin, no facelift incisions. Do not let anyone sell you skin tightening for a problem that is under the skin.

Skin? Fat? Glands? Muscle? Underlying structure? What neck/chin treatments would work best for me? (Photos)

Answers (7)

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