Do I need jowl liposuction along with my chin lipo? (photos)

Question

Hi Doctors! I am having trouble deciding if i need jowl lipos along with my chin lipo. The doctor I am seeing says he never does chin lipo without the jowls (which he considers 3 different areas) and that I will look funny if I only do the chin. I personally think I only need chin liposuction and am feeling pressured in to also getting the jowls. Do you perform chin liposuction alone ever? What is the truth behind getting one vs getting both done? What qualifies for needing both?

Jason Emer, MD · Answer

​I find that VASER liposuction in combination with Renuvion or ThermiRF are best for contouring the chin in those who are candidates, but Kybella can be used as an alternative and gets better results when combined with Thermage/Ultherapy/Exilis, TruSculpt iD, or Coolsculpting. I recommend getting a formal evaluation with an expert. Best, Dr. Emer​

Gurkan Kayabasoglu, MD · Answer

Hello. Thank you for your question. When I look at your frontal photo, I see that you have a double chin, and when I look from the side profile, I see that you have an extremely fatty under chin and small chin. Liposuction never removes all fat. My suggestion for you is submentoplasty. So what is submentoplasty? It is the process of removing all visible fat in the lowest layer with an incision made under your chin, reshaping your under chin, and clarifying your neck and jaw line. We remove the fat through the same incision and place a chin implant in your chin. Thus, you can have a very beautiful appearance both from the side and from the front. Please check our Instagram account and RealSelf photos. You can get more detailed information about me, ask all your questions about your case and send your photos to my assistants via the number in my profile. You can also book an online consultation and discuss your problems with me. Best regards.

William Portuese, MD · Answer

You do not have any jowls, and in our practice for over thirty years we have never done jowl liposuction. What you do have is a recessive chin in addition to fat deposits located BOTH above and below your platysma muscle in the neck. Consider placement of a chin implant to augment your chin forward for better facial balance, proportions, and structural support for the soft tissues in the neck. Liposuction will only accomplish removal of the fat deposits above the platysma muscle and will be minimally effective. Most of your fat is located below the platysma muscle. A surgical neck lift is required to extract that fat deposit below the muscle, which also includes a platysma-plasty to significantly improve the jawline. No skin removal is required.

Darryl J. Blinski, MD · Answer

Great posted photos. In my observation I see minor jowls that lipo would not correct without potential ski issuies. Chin sub lipo works great. I might offer buccal fat removal, HA fillers to lateral jaw line, mini anterior face lift w SMAS plication. That is why virtual consult needed....fees range from $3,000-$10,000.

Mats Hagstrom, MD (license on probation) · Answer

I typically do not go above the jawline when doing liposuction. by staying below the jaw line you get much better job line definition.
The marginal mandibular branch of the facial nerve goes right through the jowls and patience or risk for facial nerve injuries if doing Liposuction in the jowl it’s usually temporary but can be pretty upsetting to patients when it happens.
I typically do not treat the Jowl with Liposuction. I also don’t think you have significant jowls.
Delivering consistent quality liposuction results is more difficult than most people believe. I suggest anybody interested in Liposuction have at least five in person consultations.
The following are some thoughts on how to choose the right provider
How to find a provider liposuction 
Here’s the process I recommend patient take.
Start by getting pictures of your body the same way plastic surgeons take before and after pictures.
Have someone else take the pictures or use the timer on your camera. pictures should be taken from about six or 8 feet away. Don’t take pictures using a mirror.
Pictures should be taken with the camera at the same height of what’s being photographed. For the abdomen the camera should be at the height of the abdomen. for the thighs the camera should be at the height of the thighs.
Quality pictures require showing your body. Wear loose revealing undergarments that don’t press into your skin. Take pictures of your front, side and back side standing in a neutral position with your arms down by your side.
Print copies of these pictures.
Whenever reviewing before and after pictures whether you’re doing it at home or during a consultation always have your own pictures by your side for a comparison.
Understanding candidacy is key and understanding with the procedure can or cannot accomplish.
When reviewing results look for patients who have similar body characteristics to your own in the before pictures.
If they have different characteristics then what you look like and those results don’t apply to you.
Make a list of all the local board-certified plastic surgeons in your community.
Go to each providers website and document the quantity and quality of Liposuction before and after pictures posted on their website. take a peek at other procedures like tummy tucks etc. for reference. if someone has 25 sets of before and after pictures of the tummy tucks but only has two pictures of Liposuction results and that is probably not The right provider.
This will give you a general idea if providers like doing Liposuction, do a lot of liposuction and get enough quality results to post them on their websites. next choose five of those providers and schedule in person consultations.
There’s no correct number of consultation someone needs to find the best provider but the more consultations you have the better you’ll get at doing consultations including the ability to properly vet plastic surgeons and the higher your chance of finding the best provider.
Considering that a substantial number of plastic surgeons simply aren’t good at Liposuction and the number of providers who are excellent at this procedure is rare you definitely need to have multiple consultations.
Personally I do not believe it’s possible to find the right provider using a computer or by having a virtual consultations.
Virtual consultations are better than no consultation but in my opinion in person consultations are needed to get a quality assessment and to properly vet the provider.
Take careful notes during each consultation. become familiar with what quality liposuction results look like on people who have bodies similar to your own. Create a rating system for Liposuction results.
Recognize that most pictures available on the Internet either represent some of the best results because that’s what the providers usually put out on their website or disastrous results from patients who are seeking help. most average liposuction results don’t end up as pictures on the Internet.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
Bring printed copies of your own pictures of yourself.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as they had hoped.
Ask providers to only show you pictures of previous patients who had similar body characteristics to your own.
Again, there’s no point at seeing quality results and somebody who had a different candidacy for the procedure than you do.
Providers may be apprehensive to do this and will generally prefer to show you preselected images representing the best results of their career.
Why this baby more impressive to look at it does not represent average results and it is in your interest to find out what the average results look like and to get a clear understanding of how many of these procedures each provider has actually performed.
For reference an experienced plastic surgeon and should have no difficulty showing you at least 50 set of before and after pictures of commonly performed procedures like liposuction. highly experienced surgeons will in fact have hundreds or even thousands of before and after pictures of commonly performed procedures.
Obviously there are those who are earlier in their career.
Personally I recommend staying with skilled and experienced providers.
When reviewing before and after pictures look very closely at all areas treated with Liposuction. Make sure there are no skin contour irregularities in any of the treated areas. ask the provider to point out exactly what areas were treated with Liposuction and what areas were not treated. then look carefully at transition zones between treated and untreated areas.In regards to Liposuction of the abdomen I view the torso as a single anatomic unit and generally prefer to treat the entire torso as a single unit.
By treating the entire torso as a single anatomic unit patients are left without transition zones between treated and untreated areas.
The concept of treating the torso as a single unit without transition zones is less important and low BMI patients. and chubby people with over an inch of subcutaneous fat the impact of liposuction is dramatic enough that it’s not possible to have a natural transition zone between treated and untreated areas even if the procedure is done well. most people simply get a better result if the entire torso is treated uniformly. A full torso includes upper abdomen, lower abdomen, love handles (all the way down to the top of the hip dip), waist, fall back, under arm (arm pit )all the way to the side of the breast.
You should also take careful notes about the overall thoroughness of the consultation including all aspects of a complete consultation like review of medical history, physical examination, assessment, recommendation of procedures, alternative procedures, risks and benefits, complications including what complications a surgeon is had and how they are managed, preparation for surgery, instructions for recovery, revision rates and revision policy etc. 
Take careful notes about both the quantity and quality of before and after pictures any of the provider showed sufficient number of pictures of previous patient that look very similar to what you look like.
Most people don’t have a lot of experience consulting with plastic surgeons. On the other hand plastic surgeons typically have lots of experience giving consultations.
Recognize that you are the one paying for the procedure and you are hiring someone to do a service for you.
You have all the right in the world to ask for documentation including seeing a variety of results including results that were less than what the provider read hoped for.
If providers fail to cooperate then simply make a note of that and continue to the next provider.
I think you’ll find that the most talented and experience providers will be the most open minded in regards to showing you a variety of results and being truthful about what the procedure can and cannot accomplish in their hands.
Assessing patience for Liposuction candidacy is not easy or straightforward.
Even mild skin laxity can contribute significantly to contour and some areas simply don’t respond to Liposuction because of how the skin drapes especially in certain anatomic positions.
Lower extremity liposuction is technically difficult and often does not deliver the results patients had hoped for.
True saddlebags can respond well but other areas like the upper inner thigh Typically does not give the results patience and hope for and it’s prone to having contour irregularities if the procedure is not done with technical expertise.
If you have any doubts then simply slow down and schedule more consultations.
Nobody has to have liposuction.
Based on your description of yourself a question if the procedure is indicated in the first place.
Recognize that if provider selection is not done well the procedure can leave you permanently disfigured.
Good luck,
Mats Hagstrom MD

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