Curious if I would get a good result out of neck/chin liposuction alone or do I need a mini face and neck lift as well? (Photos)

Question

I'm 39 years old, 210lbs. I gained a lot of weight after becoming disabled with Long Covid. My body refuses to loose weight now for years (i'm even on tirzepatide and i'm a non-responder). For that reason, I wanted to get a little bit of my face back. I'm not fond of my side profile or when I turn my head to the side while facing forward as I have some fat underneath and around my jawline that I think might be causing some of the jowels that you see. When I went to a plastic surgeon for a quote, he initially recommended a mini face lift, neck lift and the lipo - but i'm wondering if I would just get a great result from the lipo alone. I don't feel a ton of loose skin, it all feels like fat to me. Would love to hear your thoughts.

Carl Truesdale, MD · Answer

Significant weight gain (from disability, medication, or any cause) usually creates a layered set of changes in the neck and lower face, and the right intervention depends on which layers were affected.
What happens to the neck and lower face with weight gain:
Subcutaneous fat increases under the chin and along the jawline. This is fat lipo can address.
Skin envelope stretches to accommodate the fuller tissue. If the weight gain happened recently and you've now stabilized (or lost some), the skin may or may not have retracted.
Platysmal banding can become more visible if there's also age-related laxity in the muscle.
Jowls may develop earlier than they would have, because the heavier soft tissue pulls down on the jawline.
Deciding between lipo alone and mini face/neck lift:
The key variable is skin elasticity. Do the pinch test:
Lift the skin under your chin between your fingers, hold a few seconds, release. If it snaps back instantly, skin is still elastic and lipo can work.
If it returns slowly or shows wrinkling, skin envelope is stretched and won't retract well after fat removal. Lipo alone will disappoint.
Age factor:
Under 40 with weight gain over the last 5 years: skin usually retracts reasonably well after lipo. Try lipo first.
40 to 55: variable. Pinch test is critical. Many patients in this range need at minimum FaceTite or Renuvion energy-based tightening combined with lipo.
55+: skin retraction is unreliable. Mini face/neck lift usually gives a better result even with mild fullness.
Long COVID and steroid-related weight gain:
If your weight gain was rapid (months, not years) and significant, the skin envelope was stretched fast. Skin retraction is often poorer than in slow weight-gain patients of the same age. Lower threshold for considering the mini lift.
When lipo alone makes sense:
Tight skin, isolated fat under chin, no jowls, no platysmal banding visible.
Under 40 or 50 with excellent skin quality.
Mild-to-moderate fat fullness only.
When mini face/neck lift is the better answer:
Visible jowling along the jawline.
Platysmal bands visible when you tilt your chin.
Skin doesn't snap back on the pinch test.
Over 50 with weight gain in last 5 years.
My honest recommendation:
Get evaluated by a facial plastic surgeon who does BOTH lipo and lift procedures (not one who only specializes in one). Ask them to demonstrate the pinch test on you and explain what they see.
If the surgeon recommends lipo alone and you have any of the lift-favoring signs above, get a second opinion before committing. Lipo-alone in the wrong candidate is one of the most common regret cases I see in revision consults.
What to consider before either procedure:
If your weight is still changing, wait until stable for 6 to 12 months. Both procedures give more durable results with stable body composition.
If you're on medications that affect tissue healing or have ongoing medical issues from disability, get medical clearance before any elective surgery.
Mini face/neck lift in skilled hands has a faster recovery than most patients expect &mdash; typically 10 to 14 days for major swelling &mdash; and gives a result that lasts 10 to 15+ years.

Daniel Barrett, MD · Answer

Dear Magical884981,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Anna Chacon, MD, FAAD · Answer

You mentioned:

feels like fat
minimal loose skin

That’s encouraging—but here’s the nuance:

At 39:

there is often early skin laxity, even if subtle
If you do lipo alone:
you may improve fullness
but can reveal laxity underneath
If you combine:
lipo + tightening (RF like FaceTite/Endolift) → better contour
My honest answer:

You might get improvement with lipo alone—but combination treatment usually gives a better, longer-lasting result.

Mats Hagstrom, MD (license on probation) · Answer

Adding a facelift is going to give you a potentially more impressive result than Liposuction alone.
There are many tissue layers that determine what this part of the face looks like.
That is just one of them.
A facelift will address, subcutaneous, fat, skin and the underlying Platysma muscle.
I suggest you ask providers to open up their portfolios and show you their entire collection of before, and after pictures of previous patients who have similar facial characteristics.
Bring pictures of yourself to use as reference during each consultation.
Look for providers who have extensive experience with chin and neck Liposuction.
An experienced provider should have more before and after pictures than you have time to look at them in the consultation.
Recognize that most providers are going to show you. They’re very best results.
To understand what average results look like you have to see a lot of results.
Seeing one or two examples is not going to be representative.
I suggest you have multiple consultations before selecting a provider.
In the end, the results are what matters. It’s your obligation to vet each providers skill and experience.
There is significant difference among plastic surgeons when it comes to competence for this type of procedure.
Good luck,
Mats Hagstrom MD

Curious if I would get a good result out of neck/chin liposuction alone or do I need a mini face and neck lift as well? (Photos)

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