Female, age 40, looking for best solution to remove neck fat, jowls, and the dreaded turkey wattle. What are my options? (Photo)

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

From your photo, it doesn’t look like you have a lot of chin fat. Depending on the quality of your skin, you might respond well to a nonsurgical neck lift with Ultherapy, which uses microfocused ultrasound to tighten skin. Or you you can do ThermiTight which we sometimes combine that with liposuction, for a procedure we call ThermiSculpt. Adding more volume to your mid face with Sculptra Voluma would also improve your sagging neck. And yes, a nonsurgical chin augmentation with Voluma  would strengthen your jawline, too. Consulting a board-certified dermatologist will expose you to a wide variety of wonderful nonsurgical solutions so that you can feel happy and confident again.

The good news is, at age 40, there are many surgical and nonsurgical options to correct your aging neck. These can range from very simple to quite complicated, and an in person examination and discussion will help delineate what  is going to be best for you. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut 
#realself100 Physician 

The natural aging process and genetics both play a role when it comes to jowl formation and neck laxity. Thankfully, there are several minimally invasive procedures that can address both of these issues. Profound laser boosts collagen production in the lower face and neck, whereas Kybella helps to permanently dissolve fat under the chin. In addition, you can replace lost volume with Voluma in the midface region, which creates instant cheekbones.

Genetics and aging both can lead to saggy, droopy skin features. The best combination I've found is to combine MIXTOLaserLift fractionated CO2 laser all over face and neck and supplement neck and jowl area with Kybella. Be aware that there can be some social downtime but results can be dramatic. A recent patient's sister asked her "When did you get those cheekbones?"

Since there is only one limited photograph, a thorough physical examination of the neck is required to make a determination about how best to proceed.  A major determining factor is going to be the skin tone in your neck at age 40.  If the skin tone is acceptable, then a neck lift alone can accomplish removing fatty deposits in the neck along with a platysma plasty.  If  the skin tone in the neck is very loose, then a lower face and neck lift is required to tighten loose facial and neck skin, lift the jowls, and tighten loose facial and neck muscles in addition to the fat removal in the neck.  For more information and many examples of both procedures, please see the link and the video below to our neck lift and face/  neck lift photo gallery.

Hello and thanks for your questions and photo.  You definitely have several great options to rejuvenate you lower face and neck.  You look to potentially be a great candidate for a lower face and neck lift (a consultation exam would be required to be certain).  You are not too young for this procedure. You should be a great candidate as you have laxity, sagging and loss of volume and elasticity of your lower face and neck skin.  The most frequent comment I hear from my face/neck lift patients after their procedure is that they only wish that they hadn't waited so long and had done their procedure sooner. This would also be a perfect time to add volume with a fat transfer to give you a completely rejuvenated result.  Another option, which has less down time, and can be quite effective is a FaceTite radiofrequency treatment along with contour liposuction of the under-chin area to tighten the skin and remove excess volume - the result is not as dramatic or long lasting, but will also give you a noticeable improvement with less down-time and cost.I would encourage you to schedule a consultation with a board certified plastic surgeon in order to discuss your facial rejuvenation treatment options.Best wishes!Daniel Brown, MD, FACSBoard Certified, American Board of Plastic SurgeryMember, American Society of Aesthetic Plastic SurgeonsMember American Society of  Plastic SurgeonsCastle Connolly Top DocReal Self Top 500

I highly recommend the Embrace RF procedure.  It's a combination of FaceTite & Morpheus8, performed in the clinic, while youre awake.  No visible scars, less downtime, & more economical than a traditional face lift.  

your tissue appearance at your age is not as bad as you feel. A face and especially necklift will improve the jawline and neck and a cheekpad lift will lift your own cheek and blend it to your lower lids to rejuvenate that area rather than fat grafts which can look unnatural.common to do for some of us