What’s happening with my chin? Will filler or botox be enough or would I need neck lipo? (Photos)

Thank you for reaching out and sharing your concerns regarding the changes you have noticed in your chin following your lower jaw advancement surgery and genioplasty about ten years ago. It is understandable to have questions about the best approach to address the asymmetry and “droop” you are experiencing, especially when different clinics have suggested varying treatments such as filler, Botox, or neck liposuction.

Based on your description, the changes in your chin contour could be due to a combination of factors:

Soft tissue changes over time, including skin and fat laxity, are common after surgical procedures.
Muscle activity, particularly involving the mentalis muscle, can sometimes become imbalanced after jaw or chin surgery, leading to asymmetry when smiling.
Structural changes or residual asymmetry from the original surgery may also play a role.
The fact that your chin appears normal when you force it upward suggests that muscle activity and soft tissue support are significant contributors.

Treatment Options:

Dermal fillers can help correct minor contour irregularities or volume loss in the chin area and are best for subtle, temporary improvements.
Botox may be helpful if muscle imbalance is contributing to the asymmetry, as it can relax overactive muscles and improve symmetry.
Neck liposuction is generally reserved for cases with significant fat accumulation under the chin. If your main concern is a “droop” rather than fullness, this may not be necessary unless there is visible submental fat.
In some cases, minor surgical revision or fat grafting may be considered if there is significant asymmetry or tissue deficiency.
A thorough in-person assessment by a board-certified dermatologist or facial plastic surgeon is recommended to evaluate your muscle function, soft tissue, and bone structure. Often, a combination of filler and targeted Botox can provide a natural and balanced result.

In summary, if the issue is primarily related to muscle or soft tissue, filler and/or Botox may be sufficient. Neck liposuction is typically not the first step unless there is significant fat under the chin. Surgical revision is rarely needed unless there is a major structural concern.