Don’t Put Up with that Waddle or Double Chin

There is one major change that has occurred in aesthetic plastic surgery during my career that I hear about every day in my offices. People do not want downtime. We have become a very fast-paced culture, and we all want immediate results without having to take time out for recovery. Well, who wouldn’t choose this if it were possible?

There are many new treatments and procedures that have been developed to try to correct saggy neck lines and double chins. Some work well. Others should be avoided.

Regrettably, in an era when cosmetic treatments seem to be available at spas and clinics on every corner, many providers do not have the appropriate training to identify whether or not a treatment will be effective for an individual. Patients may be led to believe a particular treatment is the answer to their prayers, when in fact it doesn’t have a chance of providing a reasonable result. You need to know the underlying problem yourself, so you can identify what needs to be corrected before selecting the treatment. Is the problem lax skin, extra fat (and if so, in what anatomic layer), lax muscle, or all of the above?

A little education can go a long way in helping you avoid disappointment.

The truth about popular neck rejuvenation procedures

The short story is that non-invasive and minimally invasive procedures do not work well for patients with sagging neck skin. We simply do not have the technology to tighten skin that is significantly lax.

What’s more, if liposuction or an injectable fat dissolving medication (such as Kybella) is used in a patient with lax skin beneath the chin, this skin actually becomes more lax. Think of it this way: if you take five pounds of potatoes out of a ten pound bag, the bag becomes looser, since it is now less full. Not the desired outcome for most patients!

Additionally, patients who are old enough to have lax neck skin almost always have lax neck muscles too. If the muscles aren’t tightened up with sutures as they are during surgery, and fat is removed by dissolving it or heating it with radiofrequency or laser, once again, the skin gets more lax, and the saggy muscles become more visible because the overlying fat is now gone.

Most patients with lax neck skin also have some jowling on their jaw lines. An isolated surgical neck lift may make the neckline beautifully angular again, but unless the jawline is also addressed, jowling becomes significantly more noticeable. Hence, you not only have to know if surgery is a better option, but which surgery is the correct one.

Don’t despair.

Isolated neck lifts can work well in some patients younger than fifty who do not have any jowling, or in some men with strong jawlines but sagging necklines, but for those of us north of fifty, a facelift is usually the best option. Surgical neck lifts and facelifts are very well-tolerated with minimal discomfort. Most patients feel their swelling and bruising dissipates quickly, allowing them to be “restaurant ready” within three weeks.

Lasers and radiofrequency treatments for sagging neck skin can bring risk with little reward

What about lasers or radiofrequency treatments like Ultherapy, Thermage, or Thermitight? A couple of zaps and all should be well. Not so fast, my friend. They sound magical, but unfortunately, laser treatments to the neck are a bit risky and fraught with disappointing results. Also, they frequently make any subsequent surgery more difficult for the surgeon because of scar tissue.

Lasers are more risky for neck skin than for facial skin because of the dramatically lower concentration of oil glands in neck skin compared to facial skin. After skin cells have been lasered, healing starts from the base of the oil glands. There just aren’t enough of these glands in the neck to allow for use of powerful lasers.

Radiofrequency treatments have left some patients with disappointing results: soft tissue contour irregularities (ripples or divots) and recurrence of laxity shortly following treatment are common issues.

What about reducing excess chin fat without surgery?

For patients with snug, good-quality neck skin but a true “double chin” caused by excess fat just underneath the skin, treatment with the injectable fat dissolving medicine Kybella is a reasonable consideration. However, this treatment is no day at the beach! Twenty to thirty injections are made during each treatment. Tenderness, swelling and bruising can be significant and last ten days or more. Treatment is generally repeated more than once for best results, and many patients simply do not want to “go through it again.”

Additionally, if excess fat is deep to the neck muscles (which only an exam by a well-qualified surgeon can determine), Kybella will have no effect, and surgery is indicated. Recovery from surgical removal of excess chin fat is generally accomplished in the same time period as from Kybella injections and treatment does not have to be repeated for years, if ever.

The best advice I can provide is to get examined by an ethical and experienced board certified plastic surgeon before deciding what you want to do to improve your neckline. At least you will obtain sound information, and you likely will avoid spending large amounts of time and money only to be disappointed by treatments that never had a chance of providing the results you deserve.

If you are unhappy with your neckline, please call my office. I will assist you in determining the best approach for you.

Categorized in: Neck Lift