We all know the patients: they walk in and hold their neck while saying "this double-chin is the only thing I care about." To our patients it seems simple enough. But to those of us who review the options on a daily basis, there is much more to the neck than meets the eye. If the patient is truly overweight, treating the neck alone may not be appropriate with any of the options available to plastic surgeons. Weight loss would be the first recommendation with a re-evaluation at a later time.
On the other hand, a young patient with an isolated fat bulge in the neck has several options. If the patient does not want any surgery, Cool-mini, the newest applicator from the Coolsculpting company Zeltiq, could be a great solution. Coolsculpting aims to dissolve the fat by cryolipolysis ("freezing the fat"). It may take one or two treatments before result are seen, somewhere around two to four months after treatment. The Cool-mini treatment takes about an hour, is painless and can be done while the patient reads a book or catches up on emails.
An injection of Kybella is another good option for the patient who has good skin tone in the neck. Kybella is a form of deoxycholic acid, a molecule that helps break down fat. When injected into the fat below the chin (submental fat), Kybella causes the destruction of fat cells over a period of one to two months. Kybella injections take around fifteen minutes to perform, and patients can return to work immediately if they choose to. The results become evident after 4 weeks. Some times a second or third treatment is needed for optimal results. On the non-surgical side, Ultherapy is a an ultrasound-based neck tightening therapy. It doesn't address the fat directly, but it can't tighten a neck that is starting to show the signs of aging.
Submental liposuction, with or without a laser, is a relatively simple surgical option for those who want to see a result faster than the non-surgical options. Liposuction of the submental area can be done under local anesthesia, and is sometimes combined with a chin implant for those who have a small chin. A neck lift sometimes incorporates neck liposuction and is also an excellent consideration for patient with good tissue tone.
As aging progresses, the loss of tissue elasticity will make it essential to treat the loose skin as well as the visible fat bulge. Facelifts address both the neck fat as well as the looseness of the skin commonly referred to as a turkey neck. The fat is treated by direct removal or by liposuction. The neck muscles can then be tightened and the extra skin removed through the facelift incisions.
In the end, a stronger jawline is the goal. Strong jawlines are considered attractive and youthful. We are fortunate to have multiple options to accommodate patients' different anatomy and also their wishes regarding recovery or quickness of the results. A consultation with a board-certified plastic surgeon is the best way to start.