Conflicting advice on chin liposuction - what impact will it have on loose skin? (Photos)

Question

I’m 46 and I have 2 concerns with regards to my neck. One being the fat pocket under my chin, and the second being the laxity in my neck skin which creates vertical lines/looseness. Regarding the underchin fat, I have received completely opposing opinions about submental liposuction. For context: that fat pocket has been there since my 20's so I would assume it's not just due to skin laxity. Surgeon 1: Examined my neck manually and feels there is a small pocket of submental fat that could be improved with conservative liposuction. He does not think removing it would worsen my skin laxity. Surgeon 2: Examined the area with ultrasound. He believes there is some fat present but it's mostly due to skin descending down from the midface, and strongly advised against liposuction, saying he considers it terrible advice because removing the fat could make the skin laxity more apparent. How would you interpret these two very different assessments? Does ultrasound provide useful additional information when determining whether there is enough superficial fat to justify liposuction? Most importantly, what impact do you think liposuction would have on the loose neck skin? Would you expect it to have little effect, or for the looseness to get considerably worse?

Anna Chacon, MD, FAAD · Answer

At 46, it’s very possible for both things to be true at the same time: you can have a genuine pocket of submental fat that has been present for decades, while also having age-related skin laxity and descent of the lower face/neck.

The fact that the fullness has been there since your 20s does make it reasonable to consider that there is a true fat component rather than assuming everything is simply loose skin.

Why the surgeons may have reached different conclusions

The first surgeon is essentially saying, “There is enough localized fat that I can conservatively reduce it without significantly affecting the skin.” The second surgeon is looking at the overall anatomy and is concerned that some of what appears to be “under-chin fullness” is actually skin and soft-tissue descent from the midface/jowls.

Neither assessment is necessarily wrong. They may simply be placing different emphasis on the underlying anatomy and on what will happen to the skin after fat removal.

Is ultrasound useful?

Yes, it can provide additional information. Ultrasound can help identify the location and thickness of the subcutaneous fat, as well as the relationship between the fat, skin, and underlying structures. However, ultrasound is only one piece of the evaluation. It doesn't necessarily predict how the skin will contract after liposuction or how much of the apparent fullness is due to tissue descent.

A hands-on examination remains very important because skin quality, elasticity, platysmal bands, jowling, chin projection, and the overall contour of the lower face all influence the result.

Could liposuction make the loose skin worse?

This is the part I would approach most cautiously.

Liposuction doesn't necessarily cause skin laxity, but removing volume from underneath already lax skin can make existing laxity more noticeable. At 46, the skin generally has less elastic recoil than it did in the 20s, so I would not assume that the skin will simply tighten beautifully after fat removal.

That said, this does not mean that conservative submental liposuction will inevitably make the neck considerably worse. If there is a relatively small, well-defined fat compartment and the skin still has reasonable elasticity, modest fat reduction may actually improve the contour without producing a dramatic increase in laxity.

The concern becomes greater when the majority of the fullness is actually coming from skin/soft-tissue descent rather than excess fat. In that situation, removing fat alone can potentially make the underlying laxity more apparent.

What I would consider most important

Rather than asking simply, “Is there fat?”, I would ask:

How much of the fullness is actually fat, and how much is skin and descended soft tissue?

If there is a small but definite fat pocket, conservative treatment may be reasonable. If the dominant issue is laxity and descent, liposuction alone is unlikely to address the underlying problem and could make the contour less favorable.

When significant laxity is present, procedures that address the skin and deeper supporting tissues—rather than simply removing additional volume—may ultimately provide a more predictable improvement. This could range from non-surgical skin-tightening approaches in selected patients to a neck lift/lower facelift when the laxity is more substantial.

So, based on the information you've provided, I wouldn't consider either surgeon's opinion automatically "wrong." The key issue is the proportion of fat versus descended/lax tissue, and that distinction is particularly important before removing volume from an already lax neck.

Yasemin Aydinli, MD · Answer

Your photos show a modest amount of submental fat together with clear skin laxity and vertical platysmal bands, and the second point is the more important one at 46. The first surgeon is right that a small fat pocket exists, and the fact that it has been there since your twenties supports that. The second surgeon is right that removing it in isolation will not tighten the skin and can make the loose skin and the bands more obvious, because the fat was partly filling the space. Ultrasound is a reasonable tool for seeing where the fat sits, but a careful pinch examination tells an experienced surgeon the same thing. I do not perform neck lifts myself, so I have no interest in steering you toward one, but speaking simply as a plastic surgeon looking at your photos, liposuction alone is not the right operation for you. A neck lift with platysmaplasty, combined with conservative fat removal, is what addresses both of your concerns and matches what is actually there.

Conflicting advice on chin liposuction - what impact will it have on loose skin? (Photos)

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