Many people come in to our office concerned about the appearance of the area right under
the chin often referred to as a “double chin” I’ll discuss some procedures known
to address the excess fat under the chin, and talk about my preferred approach for this
type of concern.
I’m Dr. Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I help my patients with a full range of solutions for enhancement of their facial features to
create balance and harmony.
Typical procedures include cosmetic eyelid surgery, face and neck lift surgery as well
as non surgical procedures such as structural volumizing, suture suspension, PRP, skin boosting,
lasers and radiofrequency treatment.
The double chin, which is referred to medically as submental fat, is made up of excess fat
or tissue located underneath the chin and jaw area.
It is a common problem that is frequently brought to the attention of cosmetic surgeons
and dermatologists.
In fact, a 2014 survey by the American Society for Dermatologic Surgery had 68% of respondents
call a double chin a top concern.
For some people, submental fat can be caused by weight gain, while others are simply born
with a persistent, natural “fullness” under the chin that doesn’t seem to go away
even with diet and exercise.
Another cause for submental fat has to do with aging.
As we get older, our skin loses tone and elasticity, thus causing the tissue and skin to sag and
pool under the chin.
It’s also important to remember that not all double chins are the same, and many people
who think they have double chins may actually just have conditions such as loose skin under
the neck and banding from neck muscles (platysmal bands).
There are 2 commonly performed procedures to remove excess under the chin fat.
These include a drug called Kybella and liposculpture, or facial lipo.
Kybella is a non-surgical injection that was FDA-approved in 2015 to specifically address
the fat present below the chin only, and is not for any other areas of the body.
It contains an active ingredient called deoxycholic acid which is naturally produced by the body
in the bile, and this helps reduce submental fat.
Kybella is dispensed via a series of injections directed into the submental fat, and works
by destroying subcutaneous fat cells.
Once these fat cells are destroyed, they can no longer store or accumulate fat.
While the exact number of treatments and injections are dependent on patient response, preliminary
studies show that up to 6 treatment sessions may be necessary, consisting of as many as
50 injections per treatment.
While people may prefer the term “non-surgical solution”, Kybella does come with some disadvantages.
Firstly, the sheer number of treatments and injections required make the procedure unsustainable
and quite taxing on the patient in the long run.
Secondly, results from Kybella takes some time to appear since a period of waiting is
required for the fat and inflammation to clear.
Thirdly, the results of Kybella is generally unpredictable as it is entirely dependent
on how the patient’s body responds to the treatment, how much submental fat there is,
and how well that fat is broken down and absorbed.
Liposculpture, or facial lipo, is a quick, tried-and-tested procedure for removing fat
fom under.
Anesthetic is delivered into the submental fat, then a micro-cannula attached to a syringe
is inserted and the fat is carefully and precisely sculpted.
In my practice, we do liposculpture with local anesthesia and LITE sedation which means the
patient doesn’t need to go under general anesthesia.
Though liposculpture is considered to be an invasive procedure — and it must be said
that any procedure that breaks through the barrier of the skin is technically considered
“invasive” which includes Kybella — I tend to gravitate more towards this method
since liposculpture is a proven, well-established procedure which yields consistent and highly
predictable results.
In addition, liposculpture is known to successfully work after just one session, and improvement
can be seen immediately.
We are typically able to accomplish what we set out to do within an hour of initiating
it, in contrast to Kybella which takes much more more time to get comparable resuls.
That being said, even with these procedures, it’s important to understand that not all
fat is bad.
Earlier in my career, it was encouraged as part of any procedure, whether it was face
lifting or liposuction, to aggressively reduce fat under the skin with the intention of creating
some type of trauma to the underlying skin which resulted in skin retraction.
Since then, we’ve learned that aggressive liposuction or aggressive reduction of fat
can actually make the skin look older, wrinkled and rippled.
A thin layer of fat is healthy for the skin, provides a youthful look, and is necessary
to create a smooth appearance.
Fat is also important for the quality of the skin.
In my opinion, this can be done more precisely with liposculpture as the openings of the
instrument can be directed away from the fat layer you want to preserve.
The diffusion a fat dissolving chemical cannot be controlled with this level of pecision.
After liposculpture, it’s typical to have some degree of swelling and bruising, much
of which resolves in about a week.
Submental fat or under-the-chin fat doesn’t only occur in people who are overweight.
It is often a genetic issue.
I’ve done this procedure for people who are physically fit but have this genetic tendency
to have a small amount of fat under the chin.
Ideally, a good candidate for this type of procedure is a younger person who has good
skin quality and tone, and they must have fat accumulation present in spite of being
within 10 pounds of their ideal body weight.
I cannot stress enough the importance of a proper diagnosis.
Many people assume that the problem area under the chin is only caused by excess fat.
This is not the case.
For example, the position of the hyoid bone can have a significant effect on defining
the neck angle.
The hyoid bone is located towards the front and middle of the neck, between the chin and
the thyroid cartilage.
When the hyoid bone is low, it shortens the angulation between the chin and the neck,
which causes the jawline to look less defined.
Poor definition of the under chin area can also be caused by excess skin.
Loose skin under the neck is caused by the gradual sagging of facial skin due to aging,
as well as weakening of the soft tissue layer under the skin that communicates with neck
muscles called the SMAS (superficial musculo aponeurotic system).
When the skin sags and SMAS weakens, the optimal solution is a facelift, or a face and neck
lift.
Another cause for concern under the chin is loose platysmal bands that cause cords to
form on the neck.
Platysmal bands refer to the neck muscles called the platysma that have become more
prominent or loose due to normal facial aging or surgery.
Many people have actually had liposuction of the chin done only to reveal more of the
platysmal bands, resulting in an even more undesirable appearance of the chin.
This problem is best treated with a platysmaplasty to reduce the protrusion and appearance of
these bands.
I advise for a proper diagnosis and treatment plan, meet with a cosmetic surgeon with extensive
experience in facial cosmetic procedures.
The introduction of a drug like Kybella has resulted in many non surgeons offer a so called
minimally invasive procedure when the same physician is inexperienced and unable to perform
any revision procedure if required.
It’s important for you to understand that proper diagnosis is critical to proper treatment.
Consumer focused messaging combined with limited scope physicians has created unnecessary issues,
which could have been avoided.
In my opinion, multiple injections with multiple treatment sessions which are expensive to
try and dissolve fat is far more invasive and inconvenient than my performing under
the chin liposuction with local anesthesia taking as little as 30 minutes.
I hope you found this information helpful, and thank you for your question.