Contouring the Neck – Methods to remove fat from under the chin

Fullness under the chin is a common concern that patients discuss during their consultation. Patients often describe this as a “double chin.” Medically, we call this “submental fullness” or “submental liposis.” Many people note that the fullness under their chin and their neck causes their side view (profile view) to look as though there is extra-skin under the neck.

The good news, is that the appearance of a ‘double chin’ can be treated safely and very effectively. There are many different ways to treat fullness under the chin.

In younger patients, the appearance of submental fullness is often due to some extra fat in this area. This is often a physical trait passed down from one of the parents. In the vast majority of situations, this results in the fullness under the chin and can be treated with many of the options listed below. Younger patients often get excellent results that can be dramatic. In younger patients, the skin is tight and once you remove the fat, the skin tightens more and you can get an excellent neck contour.

Older patients often have fullness under the chin as well as some loose skin. In these situations, patients often require combinations of the treatments discussed below and in some situations require more complex surgery like a neck lift (be sure to check out the 3 part blog on Face/Neck lift to learn more about this).

What Causes the Fullness under the Chin?

The most common cause of the fullness is some extra fat or normal fat. We all have some fat under our chin, this is a normal part of human anatomy. In some people this area will not respond to diet and exercise and can be particularly bothersome. Also, as we age, tissue around the fat loosens and can can cause the fat to ‘sag’ thus causing the fullness. In many patients, the extra fat is what is called, “pre-platysmal fat.” This is fat that is located close to the skin, above a neck muscle called the Platysma. People with pre-platysmal fat are The BEST candidates for improving the fullness under the chin without a neck lift.

Another potential cause of this fullness is a normal bone that we have in our neck, the hyoid bone. You should discuss with your surgeon if the hyoid bone is low. If it is, treatments under the chin may not help you achieve the results you desire.
Some patients also have prominent salivary glands under the chin. These can be mistaken for fat and lymph nodes but are typically normal. Similarly to a low hyoid bone, if you have this, it is more difficult to solve the problem.

What are the Main Options to treat the fullness under the chin?

Currently, there are 4 primary treatments used by Facial Plastic Surgeons and Cosmetic Surgeons

• Liposuction
• Radiofrequency Fat Reduction
• Cryolipolysis
• Deoxycholic acid injection

Liposuction for Submental Fullness or a Double Chin

In my practice, liposuction to the neck and under the chin is the most common method to treat this concern. In my experience, it is safe and very effective. Patients often have dramatic results with little or no side effects. Liposuction is considered the “Gold Standard” by which all other treatments are judged as it provides the best results.

In order to get liposuction, patients are sedated so they are relaxed and do not feel pain. A small 2-3 mm incision is made under the chin and a liposuction device is inserted. I then safely remove as much fat as I can see and feel.

The benefits of liposuction to the neck are that you get immediate and permanent results with only a small amount of downtime. Even if you put on weight, there is a good chance you will not get the same level of fullness under your chin. Patients have to wear a bandage and avoid strenuous activity for a few days after surgery.

Figure 1. Patient with submental fullness before liposuction

Figure 2. Same patient 6 months after liposuction

Radiofrequency Fat Reduction

Radiofrequency Fat reduction involves the use of a device that utilizes a focused type of energy called Radiofrequency. This device heats the fat tissue under the skin to 70 Celsius, resulting in destruction of the fat cells. This device can have variable effects on reducing the fat under the chin and in my practice, I prefer the use of liposuction.

Cryolipolysis Fat Reduction

This is the opposite of radiofrequency fat reduction, where by it uses cold. Fat is more susceptible to cold temperatures and thus these devices cool the fat resulting in destruction of fat cells.
Similar to radiofrequency, in my practice liposuction is safe and the results are much better therefore I prefer liposuction. Another reason I do not use this method, is patients develop what is called a ‘butterstick’ appearance, which looks like a large ball of swelling under the chin. This can last a few weeks.

Deoxycholic Acid Injection

Health Canada has recently approved a new medication that can be injected under the chin in order to reduce the fat. In Canada it is called Belkyra while in the USA it is called Kybella, however they are the same product. The treatment involves injecting this medication, which is actually similar to a chemical released by your gall bladder, into the fat under the chin. This chemical destroys the fat cells. Patients often have significant swelling for 2-3 weeks after the procedure, more so than with standard liposuction. In addition to this, there is a 4-5% risk of damaging the nerve that controls the muscle around the corner of your mouth. If this occurs, you will have weakness and an abnormal appearing smile. This can be permanent in some patients.

Some patients require more than one treatment with this medication so even though one treatment costs less than liposuction, in the end it may eventually be the same.

What are the Risks of Liposuction treatment of the Fullness under the chin?

As far as a procedure goes, this is one of the safest surgical procedures. There is always a risk of bleeding, infection as well as a small scar. Many patients have a small amount of pain that lasts a few days.
Damage to a nerve that moves muscles of the face is extremely rare with this surgery, but it is possible.

Summary

For patients with extra fat or fullness under the chin, my most common treatment I recommend is liposuction. Although other treatments are available, their results are more inconsistent and variable. In capable hands, liposuction of the neck and liposuction under the chin is safe and effective. We are always happy to discuss concerns such as this in our clinic.

Dr James P. Bonaparte, MD, MSc, FRCSC
Ottawa, Ontario, Canada
Head and Neck Surgery
Practicing in Facial Plastic and Reconstructive Surgery
Facial Cosmetic Surgery