Q: Dr. Eppley, I have 3 procedures I am considering. The breast reduction and/or lift is something I definitely want to do, as I’m very uncomfortable from the weight pulling on my neck. Over the past few year I have noticed facial asymmetry developing. It seems to be from an enlarged masseter muscle and I’m curious what my treatment options are for this. Lastly, regardless of how thin I am, I have always had somewhat of a double chin. My chin is not very pronounced and I’m curious if a chin implant would be a good option to fix this? Do you offer discounts when multiple procedures are done? Anything information you can provide would be greatly appreciated. I can provide pictures. Thanks for your time.
A: The breast reduction surgery is fairly straightforward and the inferior pedicle technique with the anchor scar pattern is well known. Masseter muscle hypertrophy is most commonly treated by Botox injections which can have a profound but often temporary effect. Surgical reduction through electrical cautery reduction is also an option if one happens to be undergoing another surgery. When it comes to the double chin, chin augmentation by an implant ir sliding genioplasty is often done. But often this alone may be inadequate so neck liposuction or a submentoplasty combined with it usually produces the best double chin correction. I would need to see pictures of your chin/neck to give a more educated recommendation for your double chin anatomy.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in double chin correction. Attached you will find some pictures that I took–today during my lunch break! Looking at me straight on, at a flattering angle, you can tell I have a round face but the double chin isn’t noticeable. When I smile widely, laugh, or am viewed from my profile, it is clearly evident. What are my treatment options? Will liposuction alone work as another doctor told me? Let me know your thoughts!
A: Thank you for sending your pictures. While there is certainly some subcutaneous fat to liposuction, that will give you a modest improvement only. Necks like yours almost always have a subplatysmal collection of fat in the midline that will not be changed by liposuction. This requires a submentoplasty technique to maximally tighten the neck angle. You also have a bit of a horizontally short rounder chin. This adds a third factor to the double chin appearance. Adding a small central button style chin implant will add a little more horizontal projection and change the frontal chin shape to more of a tapered chin look.
In conclusion, it is all about the degree of double chin correction you are seeking.Liposuction alone will produce a modest improvement, a submentoplasty (which includes neck liposuction) will make a good change and the final addition of a chin implant will make the best overall double chin correction. As you can see neck liposuction is the most basic approach but does not produce the best double chin correction.
Dr. Barry Eppley
Q: Dr. Eppley, I am hoping to set up a consultation with you to discuss the possibility of undergoing chin/neck liposuction for double chin. This is something I am quite self conscious about and have considered off and on for years. I am not overweight, but regardless of my weight over the years, I have always had it. I am actually a nurse at one of the local hospitals where you work and have cared for many, many of your patients! Although I haven’t had the pleasure of meeting you in person, I have worked very closely with your team of residents, fellows, and fellow staff physicians. I spoke at length yesterday regarding the matter with one of the local plastic surgeons. He explained to me the risks and benefits, length of time I would be out of commission, and what to expect with results. He is on board if I am. But with all procedures, especially cosmetic ones, I know that it is important to get multiple opinions. I am just curious to hear what you think as well.
Please let me know at your earliest convenience!
A: When it comes to double chin correction the question is not whether you can undergo liposuction of the submental and neck region, it is just how effective it would be in achieving the goal of reducing/eliminating the double chin. There are numerous components that make up a double chin which include the fat layers (subcutaneous and/or subplatysmal), amount of bony chin/jawline projection and the tightness or laxity of the platysmal and hyoid musculature. Knowing what anatomic elements comprise the problem will allow one to choose the best treatment. If all of the double chin problem is subcutaneous fat, then simple liposuction will suffice. But if there are other elements that contribute to the double chin then the result from liposuction may be less than completely satisfactory.
Without seeing pictures of you, I can not say how any of these anatomic/diagnostic considerations may apply.
Dr. Barry Eppley