38 year old in generally good shape, with double chin, asymmetrical heaviness a of lower face...what is the best option?

There is really nothing to talk about.  You should absolutely have chin liposuction because it will improve what is bothering you in about 45 minutes.I suggest laser assisted or "Smartlipo" because I like the effect the laser gives to the skin.Please check out the blog post I will list along with this answer.  It will inform you of why I love this procedure so much.  Incidentally, we do NOT charge more for the laser portion of this procedure.Good Luck!

I have been doing micro liposcultpture in that area with excellent result.  The laser would not add much besides expense. 

You may benefit from liposuction done within your doctor's office. During your initial examination, your #chin will be evaluated along with the neck and jawline. A weak #chin implies a lack of chin support for the skin along the neck line. In younger individuals a chin implant alone is usually all that is needed to improve the appearance of the neck. Subsequently, it will also improve the overall #balance of the face and can create the illusion of a smaller nose. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of #aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results.
Also, the presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine if you are a #candidate for #rejuvenating the neck. Often, #liposuction can be used with a neck lift or in place of depending on the amount of body fat in that area.A board certified plastic surgeon should evaluate both your anatomical features and aesthetic goals to determine if a neck lift and/or #chin procedure best suits your individual needs. In some cases your plastic surgeon may give you more than one option to choose from. If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend non-surgical alternatives to address your concern.

The question you ask is an excellent one. Given the photos
you have provided I feel that the best approach is a minimal approach. There
are additional deposits of fat under the neck that can be removed with
liposuction as well as possible tightening of the muscles in the region though
the same liposuction incision. These are very self-evident given the images you
have provided and I feel that you would have an excellent result. What is not evident
is the all too common over-sophistication of such procedures with fancy
machines that add cost, but do not considerably improve your overall results. Hopefully this is helpful to you.Be healthy and be well, James M. Ridgway, MD, FACS

Hello.  Based on your photograph,  you would be an excellent candidate for chin liposuction.  You appear to have elastic skin with a good ability to spring back,  which means that it would likely redrape well after removal of the fat underneath it.  This procedure is a very high return on investment,  and taking out a small pocket of fat in this area usually yields a dramatic improvement from a cosmetic standpoint.  A double chin on a person who is otherwise slim often makes them appear heavier and older than they are. There is a very good chance that liposuction of this spot would give you the result that you are looking for and balance out your jawline with the rest of your physique. 

Double Chin Treatment -- SmartLipo, Botox, Venus LegacyI treat this everyday in my practice. You do not need surgery. Properly performed liposuction with laser and physical fat removal will do fantastic to remove the fat, lift the skin, and contour the jawline. I pretreat everyone with Botox 1-2 weeks before surgery to relax the neck muscles, allowing for better retraction of the skin after surgery. Then after treatment we do skin tightening with Venus Legacy to improve the results and decrease the neck swelling. I suggest you only see an expert for treatment of this area as a meticulous surgeon is required to get great results and complications in this area can be devastating both medically and cosmetically. Best, Dr. Emer. 

In the neck,  there are fatty deposits located above and below the platysma muscle. A neck lift with  removal of the fatty deposits above( sub-mental fat) and below the muscle( sub-platysmal fat) along with the platysma plasty is required to give a more refined jawline. No skin removal is required. For many examples and more information, please see the video and  the link below

You present a challenging situation.Your double chin is evident in your photographs.Part of what's causing this is the lack of jaw definition.At the same time, you have a very forward-pointing chin, making you a less-than-perfect candidate for a chin implant.Perhaps liposuction of your chin and neck is a good place to start.I suggest you follow up with a superbly talented plastic surgeon with experience.Best of luck,Mats Hagstrom, M.D.

Sherry,  A new drug promises to get rid of double chins without surgery, and it’s nearing federal approval. The drug, an injectable substance that dissolves fat under the chin, was unanimously recommended for approval this week by a Food and Drug Administration advisory committee, but it’s still awaiting final approval from the agency. It’s a version of deoxycholic acid, “a naturally occurring molecule in the body that aids in the breakdown of dietary fat,” according to its manufacturer, KYTHERA Biopharmaceuticals, based in Westlake Village, California. They’re calling it ATX-101 right now. Follow the link below for more info