Addressing the Double Chin

The double chin is one of the least desirable traits that patients complain about the most. Having a smooth, graceful-looking neckline can enhance a patient’s appearance, especially with working remotely and the rise of video teleconferencing, which can magnify imperfection in this area. There are several treatment options of a full, sagging, or wrinkled neck that can help mitigate this issue, including a chin implant, liposuction, neck lift, Kybella (deoxycholic acid), and some laser/radiofrequency devices. Improving the appearance can shave years off of the face. It can also help to restore balance to the face by defining the jawline more effectively, which frames most of the lower face.

A Chin Implant

A chin implant is a relatively simple procedure in which a small incision is created below the chin and a silicone implant is inserted. The implant itself is silicone and can be custom fit or pre-designed, which comes in various sizes (small, medium, large). The implant is placed over the bony structure on the lower jaw (mandible) to achieve a stronger, more pronounced chin to balance the appearance of the face. It is a simple, nearly painless procedure and can be done under local anesthesia.

A chin implant can be performed as a standalone procedure or combined with others, such as a neck lift or liposuction to the neck using the same incision. Chin implants can be used as an adjunct treatment to refine the neckline and also to add definition to a weak or naturally receding chin as the bone resorbs with age.

Liposuction of the Neck

Liposuction of the neck can be performed to target an excessively full chin in patients who may have a “double chin,” whether they are a healthy weight or trying to achieve weight loss. As a standalone procedure or combined with others, liposuction can also help to achieve a more defined and graceful neckline.

Patients who have liposuction of the neck range in age from 20 to 50 and typically need to have better skin elasticity than older patients, which allows the skin to contract as it is healing. Goals and considerations for liposuction in the neck area should include improving the appearance of a double chin or fullness underneath the chin and refining the jawline to create balance or enhance the chin/mandible.

Liposuction of the neck is a relatively quick procedure for most patients and can be performed under local anesthesia using one or two small incisions hidden beneath the chin or behind the ears. During the procedure, the surgeon inserts a small diameter cannula to remove excess fat and sculpt a natural contour of the neck and chin. Patients then wear a support strap or bandage for three to four days, can generally return to work in about a week, and can resume full activity within about two weeks. Most swelling/bruising afterwards resolves within 10 to 14 days after the procedure.

While liposuction of the neck is effective for removing excess fat, it will not do much to improve sagging skin, the quality of the skin, or wrinkles that naturally occur due to aging. Patients with a good skin tone and skin elasticity will see the best results and this procedure can be used alone or combined with a chin augmentation or a platysmaplasty to further enhance facial contour. Results are long-term provided the patient does not gain an excess amount of weight.

Platysmaplasty

A plastysmaplasty, or neck lift, is a procedure that generally targets saggy, loose skin on the neck. It is also referred to as a cervicoplasty, “to remove excess skin or to tighten loose neck muscles.” The goals for this procedure are to tighten loose neck muscles, remove excess and sagging skin, and redefine the. A neck lift can be performed as an outpatient under IV sedation or general anesthesia and is typically done through small incisions behind the ears and underneath the chin. The result is a more youthful and defined appearance of the neck. Patients can generally resume normal activies and return to work in around two weeks, though feelings of tightness in the neck may take longer to subside.

Results are long term and include smoothing out wrinkles and creases, improving vertical neck bands, and eliminating excess and saggy skin. Post platysmaplasty the neck will continue to age naturally. This procedure can be combined with other procedures for more comprehensive facial contouring or rejuvenation.

Future Directions

The above-mentioned procedures are some of the most common ones requested by patients trying to achieve rejuvenation of the chin, jaw, neckline or overall facial contouring. It is best to present the various options to patients so they understand the pros/cons and are able jointly make a decision with the physician to meet their goals. Importantly, treating and achieving the ideal contour of the neck and chin is not defined by one particular technique but by a patient’s unique circumstance and his or her aesthetic goals. Many of these procedures can be performed alone or combined with others for a comprehensive improvement to facial contouring.

References:

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Trevidic P. Neck contouring. Clin Plast Surg. 2014;41(1):81-83.

Labbé D, Giot JP. Open neck contouring. Clin Plast Surg. 2014;41(1):57-63.

Batniji RK. Complications/Sequelae of Neck Rejuvenation. Facial Plast Surg Clin North Am. 2014;22(2):317-320. doi:10.1016/j.fsc.2014.01.007

Waltzman JT, Zins JE, Couto RA. Face and Neck Lifting After Weight Loss. Clin Plast Surg. 2019;46(1):105-114. doi:10.1016/j.cps.2018.08.012