Double Chin Treatments At A Glance
- Best Results2-3 treatments
- Treatment Recovery1-7 days
- Procedure Time20-60 minutes
- Skin SpecialistNurse, Davin Lim
- Duration of ResultsMany years to permanent
- AnaestheticAs required
- Back to Work1-5 days
Double Chin Treatments
Double Chin Treatments or submental fat is due to genetics, weight gain & age. Though the problem is easy to visualise, the optimal treatment may be complex. My algorithm encompasses non-surgical procedures including fat dissolving injections, dermal fillers, HIFU energy devices, RF skin tightening, Coolsculpting as well as surgical techniques such as liposuction.
FactsFacts on Double Chin Treatments
What causes a Double Chin?
The three main factors are age, genetics & diet.
Age. As you start to age, your metabolism slows down. Fat- adipose tissue accumulates in different areas throughout the life cycle. Submental fullness or double chins/chin fat starts to accumulate in the late 20s & peaks in the 40s. Loss of collagen compounds this problem. This results in skin laxity. Hence with double chins it is both accumulation of fat & skin laxity.
Genetics. If you have the genetic tendency to have more fat cells in the chin area, chances are you will get a double chin as you age. Other factors that come into play include chin projection & jawline definition, as both tie in with the under-chin area. Underdevelopment of these structures can accentuate the appearance of double chins.
Diet: Over time fat accumulates in this area, partly due to a change in metabolism. Losing weight may help reduce the appearance of double chins.
What effective methods are there to reduce double chins?
How does fat dissolving injections work?
Fat dissolving injections or deoxycholic acid is a naturally occurring bile acid produced by the body to metabolise fat. This chemical can be injected in double chins to reduce fat.
The advantage of injections include; minimally invasive procedure (injections), relatively easy to perform. The cost can be spit up over a series of injections.
The disadvantages of injections are significant. This is my least favourite method for the following reasons.
- Significant pain during the procedure (this can be alleviated by numbing injections)
- Significant swelling & bruising that last 5 to 8 days (this is universal)
- Fat dissolving is delayed & not predictable in the outcome
- 2-4 sessions are required
- Skin tightening is not predictable
- Facial nerve injury in 4.9% of cases
*It is not that I do not perform this procedure, as I use deoxycholic acid for melting fat elsewhere. My main argument is that there are far better, more predictable & cost effective procedures as listed below. The biggest disadvantage of this procedure is the total or cumulative downtime, one week recovery multiplied by three equals three weeks of swelling.
How does Coolsculpting work?
Coolsculpting Mini works by a process called cryolipolysis, namely fat freezing. When fat cells are exposed to very cold temperatures, they undergo apoptosis or cell destruction.
The advantage of Coolsculpting is that this procedure is non-invasive with a relatively quick recovery time (swelling 2 to 3 days). Once fat is destroyed the cells are gone forever. Most patients require 2 to 3 sessions for optimal outcomes.
The disadvantage of Coolsculpting is that effective cryolipolysis relies on –
- A good application seal of the device.
- A suitable ‘pinch’ of fat (as opposed to skin laxity)
- Applicators to be placed accurately on the treated areas (depends on the shape of the double chin / excess fat)
- Immune system to remove the destroyed fat cells after the treatment
*After liposuction, Coolsculpting Mini is my preferred treatment as downtime is minimal compared to Kybella or Belkyra.
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How does Ultraformer III work?
HIFU or High Intensity Focused Ultrasound is also known as Microfocused Ultrasound. The two stand out devices are Ultherapy & Ultraformer III. I use the former for lower face lifting, whilst the later can be used for double chin reduction. It works by delivering energy below the surface of the skin, into the fatty tissue damaging the fat (off label).
On label treatments contract the collagen under the chin & neck area. This provides skin tightening. In most cases one treatment is required. I often combine this with liposuction to achieve better results.
What does liposuction do & why do I prefer this treatment?
I totally get non-surgical treatments as these are less invasive & less scary (hence why I offer half a dozen alternatives to treat double chins). The flipside is that I prefer liposuction for the following reasons-
Predictable outcomes: Other treatments rely on your immune system to remove fat. Liposuction relies on me to physically remove fat. I trust my skill sets more than your immune system. On average I remove between 20 ml to 140 ml of fat from the under chin area.
Only one session needed: 95% of patients require only one liposuction procedure. This compares favourably with Belkyra (2-4 sessions), & Coolsculpting (2-3 sessions).
Fast recovery times: Believe it or not, the recovery is over 8 times quicker than fat dissolving injections. After liposuction, you are in a neck support brace for 24 hours. There after it is worn at night for another week. Swelling goes down within 36 hours post surgery. Bruising takes a little longer.
No pain: Seriously, this treatment is painless (unlike fat dissolving injections). I perform this procedure under mild sedation. The entire procedure is well tolerated.
Skin tightening: Liposuction can provide skin tightening via controlled dermal remodelling. In some cases I use RF during the procedure, in other cases I use HIFU. These procedures act synergistically with liposuction to contract collagen in the neck & under chin area.
More cost effective: It is not uncommon liposuction patients to have trialled (and failed) all non-surgical modalities. By the time one adds up treatments & time taken off work, liposuction is still one of the most cost effective & clinically effective treatments for double chins.
Do thread lifts really work?
Yes. Threads have a somewhat predictable outcome if used correctly. Namely in patients with little sun damage & mild to moderate laxity. I use both monofilament PDO MINT threads as well as suspension threads. I also combine threads with devices like HIFU, RF, & other skin tightening methods.
The downside of thread lifting is the limited duration of efficacy, they typically last 3 to 6 months. A one year duration is exceptionally good, rather than the rule.
What can RF microneedling achieve?
What RadioFrequency devices do I use to tighten the chin & jaw line areas?
RF devices are best combined with other modalities including collagen stimulating fillers, threads, & lasers.
- RF delivers heat. This contracts collagen & provides skin tightening
- Heat can be delivered slowly with multiple sessions – Pelleve or Tempsure
- Heat can be delivered fast in one session- Thermage
- Slow heating gives more predictable results, namely Tempsure or Pelleve
- Slow heating is more cost effective
- If I require fast high power heating, I do it with ultrasound guidance, namely Ultraformer III or with Ultherapy
*The main reason I do not recommend Thermage is the fact that like all other skin tightening devices, patient selection is critical. The cost to the patient for a single treatment (which has a true efficacy rate of around 20%) is enormous. In truth, Tempsure has a similar efficacy however it is much more cost effective (and comfortable) for the patient. If I require significant tightening in the correct skin type (thick dermis, little or no sun damage), I prefer HIFU devices such as Ultherapy.
Are the results permanent?
The majority of results are long lasting. The most predictable results are with liposuction as I am physically removing between 20 to 100 ml of fat from the area. This means fat cells are physically extricated. The remaining fat cells do not multiply, so by definition the results are permanent.
The caveat is that the remaining fat cells (approximately 10% of adipose tissue), may increase in size with lifestyle changes. Hence if you gain weight (fat), these cells may increase in size, but not number. Keep your lifestyle healthy, & this is not a problem.
What is a problem is getting older. This I have no miracle fix for. Remember the second aspect of treating the submental area is skin & tissue laxity. Over time tissue will loosen. The speed of loosening & collagen breakdown is determined by your genetics (I don’t control this) and your lifestyle choices (smoking, UV, increases collagen breakdown).
Another important fact to grasp is with bone resorption with age. 2 key elements to consider are chin projection & jawline definition. Reduction in bone mass will result in loss of traction of the skin for the under chin area. Solution? Dermal fillers. If you are opposed to dermal fillers, consider seeing a maxillofacial surgeon for implants.
What is the relationship between chin protection and jawline definition & double chins?
This is an easy concept to understand. Having a small or recessed chin & poor jawline definition results in a poor support for the underlying chin area. If you provide traction & support in these areas you ‘stretch out’ the skin overlying the double chin. Think of it as countertraction when you support a tent.
By building up a recessed chin you place traction in an anterior or forward vector. This stretches your under-chin skin forward. By supporting & contouring your jawline area, it provides lateral support to stretch skin sideways (on both sides).
I use dermal fillers to recreate contours & re-volumize. In some patients this may be enough to reduce the look of submental fullness without actually removing the fat.
Why are the benefits of lifestyle modification for double chins?
You can potentially reduce your double chin by losing weight. More importantly, to maintain the effects after liposuction & other fat removing methods, keeping a healthy BMI will ensure that fat cells do not increase in volume.
Sun protection is especially important in Brisbane & the Coast as UV damages collagen. This results in skin laxity of the face & neck, accentuating the bulge of double chins. Simple sunscreen coupled with skincare vitamins will prevent further damage.
What is the cost for double chin treatments?
The cost depends on the extent of your double chin & the complexity of treatments. Surgical options such as liposuction are usually more cost effective because it requires only one treatment. Results are predictable. Non-invasive treatments typically require 2-4 sessions. To see what treatment options are available, book for a FREE* consultation with my nurses & clinical team.
As a guide:
Fat dissolving injections: $990 to $1300 per application (2-3 required)
Fat freezing: $750 to $1500 (depending on number of cycles & applicators)
Dermal fillers: $750 to $1290 per ml (nurse vs myself)
Ultraformer III & Ultherapy: $ 700 to $1990 (depends on the extent)
Thread Lifts: $990 to $2990 (depending on number of threads)
Liposuction: $3990 to $5990 (depending whether I use skin tightening as well)
RF Tightening: $790 to $990
RF Microneedling: $990 to $1990
Davin’s Viewpoint: Double Chins & how to treat
There are many ways to address submental fullness, from Belkyra/Kybella fat dissolving injections, Coolsculpting Mini, heating devices like Ultraformer III, off label microneedling RF, Vaser liposuction, RF tightening devices like Facetite as well as surgical options including liposuction.
Here are the facts: the most predictable, cost effective & probably the best solution is with liposuction. Here is why-
- Predictability: Liposuction relies on the surgeon physically removing excess fat & fat cells. Non-surgical treatments including Ultraformer III, fat dissolving injections & cryolipolysis (fat freezing) rely on your immune system to destroy & carry fat away. This is unpredictable.
- Downtime. Recovery from liposuction is really quick. A neck support brace is worn for 24 hours post procedure, then only at night for one week. Swelling goes down within 48 hours after liposuction. Conducted on a Friday or Saturday am, you can go back to work on a Monday. For fat dissolving injections, expect swelling to last one week. Multiply this by 2 to 3 and you have up to 3 weeks downtime.
- Adjunctive skin tightening: Remembering the two most important causes of double chins are skin laxity & accumulation of adipose tissue/fat. During liposuction I also employ techniques to tighten skin. The results? More predictable results & jawline definition. Most of my cases I combine laser, HIFU & or RF devices to produce skin tightening.
- Cost effective. By the time you add up the cost of fat dissolving injections & cycles of Coolsculpting, liposuction is a cost effective alternative.
Of course you may not be suitable for surgery, or have a personal wish not to have liposuction. In this case my advice is to consider cryolipolysis with Coolsculpting Mini. This treatment takes 40 to 80 minutes, depending on the location of fat & extent of treatment. I do believe that cold therapy is more effective than heat therapy. We currently run 2 fat freezing devices including Coolsculpting & Cooltech.
Other options include fat dissolving injections (I hardly use this, purely based upon the downtime to the patient), as well as heating – microfocused ultrasound with Ultraformer III. The latter I use more often as a tightening device, at the same time as liposuction.
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