Each unique person‘s facial appearance is primarily based on facial skeletal structure. It is the balance or lack of balance between the different segments of bone in your face and skull that determines what you look like. soft tissue coverage tends to be very consistent from person to person and while things like obesity and age will alter soft tissues it is skeletal structure that determines whether someone is attractive, less attractive, masculine or feminine. In your case your mid face or maxilla is dominant and quite tall especially in comparison with your mandible which is small in both forward projection and vertical height. This causes the soft tissues to drape the lower part of your face and neck differently. Individuals who have a large projecting mandible tend to always have well-defined jaw lines and don’t get a premature double chin. it’s not a problem of having an abnormal fat distribution it is how the soft tissues drape based on underlying bone structure that creates the problems you’re concerned about. The problem can either be addressed by treating the primary problem through cranial facial surgery or an attempt at corrective with soft tissue manipulation. All of your proposed procedures are soft tissue manipulation none of them will address the primary problem. When patients reach for soft tissue manipulation as a treatment for problems that are fundamentally based on bone structure the results will be less than ideal or partial. Buccal fat removal can give good results for some individuals but is also well known for creating highly undesirable lack of facial volumes especially with age. for that reason I typically steer almost all patients away from buccal fat removal. Liposuction of the Chin neck can give a very impressive results especially on young people with tight skin who have enough fat to work with. it may deliver a nice improvement but it does not address the underlying primary problem. To get an accurate assessment regarding fascial Aesthetics from a facial skeletal perspective I suggest having consultations with oral surgeons or board-certified plastic surgeons with cranial facial surgery backgrounds. regardless of what procedure you choose it is always a good idea to have an accurate and correct understanding of what the fundamental problem is. Know all your treatment options before choosing any one single treatment. Many individuals are willing to undergo something that seems simple and low risk and the idea of having your facial bone structure taken apart and put back together with titanium hardware may seem daunting and simply too much. Nobody has to have cosmetic surgery. In order to deliver a consistent hire patient satisfaction and quality results does however require the providers have a clear understanding of what the problem is and the treatment options are directed at treating the problem. Facial aesthetics it’s a pretty complex field and both patients and plastic surgeons often look for soft tissue solutions for skeletal structure problems. I suggest consulting with a variety of different providers to get well acquainted to all the various treatment options. That should include providers who do cranial facial surgery. If you opt for a liposuction or for that matter any cosmetic surgical procedure I recommend choosing your provider carefully. Vet providers I have a multiple in person consultations. During each consultation ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in. Experience providers who do procedures frequently should have no difficulty showing you at leasr 50 set of before and after pictures. Being shown a handful of preselected pictures which most likely represent the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually performed. Ask providers to show you as many examples of patients who have similar facial characteristics to your own. Familiarize yourself with what quality results should look like based in reviewing lots of before and after pictures online before your consultations. Look for patients who are of similar age and have similar facial proportions. Get quality facial pictures showing your face from the front and side the same way plastic surgeons take before and after pictures of the face, print those pictures and bring them with you for reference during each consultation. Use pictures of your own face when reviewing before and after pictures to make sure you’re selecting pictures of other patients who had similar facial characteristics. Some people are good candidates for chin and neck liposuction while others are not. It may not be easy for those not trained in this specialty to make an assessment of who is going to get quality results and who is not but you can get the general idea by looking for similarities to your own facial characteristics Create a rating system or a grading system for quality outcomes. Take notes during each consultation regarding how many and the quality of results each provider shows you. Top-notch providers tend to be detail oriented both during surgery and during consultations to. Make notes of how much time each provider spends with you during the consultation especially how thoroughly they discuss your assessment, before and after pictures, preparation and recovery, revision policy, risks and benefits and alternative procedures. Listen to what each provider has to say and listen carefully to what they recommend. Continue having consultations until you feel very comfortable with the providers recommended surgical plan and that provider doing your treatment.When in doubt slow down and schedule more consultations. Do not rush or choose to have permanent and irreversible procedures without doing the appropriate vetting of providers and having a clear understanding of the procedure and what you can expect. The process is complex, can be intimidating and there is a learning curve to how to consult for cosmetic surgical procedures correctly. The more consultations patients have before they choose that surgery the better they get to doing consultations. In the end find the right plastic surgeon and everything falls into place. Good luck, Mats Hagstrom MD