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!

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