Why do I still have a double chin & jowls? Can any more fat be taken from my chin? (Photo)

Question

I had lower neck lift and chin lipo suction in March 2023. I am still showing a double chin and the lower facelift hasn’t addressed my jowls. Can anymore be taken from my chin? My surgeon says not. And should my jowls still be showing after a lower neck lift?

Lucian Ion, FRCS · Answer

Thank you for your enquiry.

Repeat liposuction would not be a good solution. However, it is possible to reduce more volume under the chin including fatty tissue, all of which would be from the space deep to the platysma muscles. It requires a 3 cm access under the chin and leaves a corresponding scar. It is referred to as deep plane neck lift or deep neck lift.

On its own, a neck lift procedure has limited impact on the jowl appearance. A deep plane facelift manages the jowls more effectively.

A combination of deep plane neck lift and deep plane face lift is likely to address your concerns.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jeffrey H. Spiegel, MD · Answer

From your photos it seems you may need a chin implant or genioplasty.  Think of it like a clothesline.  It will sag if the posts are too close together. Bringing your chin forward should balance your face and permit a tighter neck line. It is also possible your surgeon didn't remove tissue beneath the platysma muscle ("a deep neck lift") which can also be addressed.

Mats Hagstrom, MD (license on probation) · Answer

There are basically two variables that determine quality outcomes when it comes to most cosmetic surgical procedures. The first is the patient candidacy for the procedure, and the second is the skill of the provider.
To make an accurate assessment regarding the outcome of a procedure we always need to see a complete set of proper before and after pictures. If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Primary facial aesthetics inherently based on bone structure. Facial aging has much more to do with soft tissues, but the bone structure in many ways determines who is going to show signs of premature aging, especially in the lower 1/3 of the face.
There’s also going to be major differences and outcomes based on who does the procedure. Delivering high-quality, consistent. Facelift procedures is not a beginners operation.
The number of classic surgeons who truly mastered this procedure are neural relatively select group.
It’s very important to vet plastic surgeons properly when choosing providers for any permanent irreversible operation. I recommend people do that by starting the process scheduling multiple in person consultations with providers in your community. Depending where you live, you may need to travel for surgery, but I generally recommend patient start looking close to home.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar facial characteristics to your own.
An experienced provider who should have no difficulty showing you the before and after pictures of at least 50 previous patients.
 Being shown a handful of pre-selected images, representing only the best results of the 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 operations them actually done.
The biggest mistake patients make is scheduling only one consultation and then scheduling surgery. This completely eliminates the ability to choose the better provider.
 at this point if you want to improve the outcome, you’ll need to get a quality assessment for a secondary facelift.
The process is more or less the same Rising that secondary procedures can be more complex and difficult, depending on how the first procedure was performed.
Best,
Mats Hagstrom MD

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