Do i need a neck lift, neck lipo, a chin implant? Something else?
Thank you for your question.
You submitted your question with 2 photos of the lower part of your face.
One with you appearing to look straight ahead and one with your chin downward.
And you stated in your question that from the side, you look pretty good when your face
is looking straight.
And then when your chin goes down, there’s all this appearance of extra skin so you want
to know do you need neck liposuction, chin implant or what essentially is the solution
for your appearance of your neck when your chin is moved downward.
Well, I can certainly share with you how I have this discussion with my patients who
frequently have comparable and similar concerns.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And helping people improve the appearance of their neck has been a big part of my practice,
doing everything from face lifting, face and neck lifting, liposuction, chin implants as
well as injectable fillers to help improve the appearance of this area.
So I can tell you that in my career over the course of these past 20 plus years, there
is certainly greater understanding of what are some of the anatomic issues that are responsible
for this change which is typically associated with facial aging.
So to begin with, it’s important to understand that there is a certain element of this that
is or significant part of this issue which has to do with the skin’s elasticity.
And what I mean by that is that as we get older and the soft tissue under the skin gets
thinner, the skin’s elasticity, the relative proportions of different types of collagen
and other proteins in the skin changes.
So very often, people, as they are getting into their 40s and older, will come to me
and pull their skin and watch that the skin doesn’t retract as well and go, “What am
I supposed to do with this?”
And they think, “Why can’t you just tuck it or pull it all the way from the back of
the neck?”
And so certainly, in the earlier part of my career, the approach would typically be to
do some kind of face lifting procedure.
Basically, what you’re doing with the facelift procedure is you are taking care of any redundant
skin and you are increasing the tone of that area.
That doesn’t mean you eliminate everything when your chin goes downward, it improves
I’m not saying that’s necessarily the right thing for you because there are other
areas that also have to be evaluated before making that decision.
One of the things that I have also noticed as time has gone on having been around for
the pre-internet era and seeing what has transpired as everyone is looking at their smartphones
is that generally, I’m finding that posture has incredible impact on this area in what
people see when they look in the mirror.
I feel that people’s postures in terms of their back and shoulders are getting more
They’re rounding forward, holding their phones closer, their necks are extended forward,
and they’re hunched over.
You can look around and notice how many people have changed their posture, and that contributes
a lot to this appearance of excess.
I have taken a patient with a similar concern, and I just adjusted their posture, not anything
chiropractic, but just have them bring their shoulders back, and their chin up, and aligned
their ear to the shoulder, then a considerable amount of neck skin has miraculously improved.
Now that being said, the other element of facial aging that I think is really relevant
here is also having to do with relative bone loss.
And a lot of times and again, judging is based on a limited photo, but assuming that the
photo is representative of someone who has a relatively thin face and is in their 40s
or older, there is an approach where you are actually adding volume to the diminishing
What I’m saying is essentially, as we get older, this is documented in the plastic surgery
literature, there’s bone loss and with that bone loss, comes this relative deflation of
the foundation of the face and the skin appears to be excess.
So what we do is we do something called Structural Volumizing which means we are using fillers
that are on the thicker side such as Juvederm Ultra Plus and Juvederm Voluma and placing
it strategically such as in the cheekbone area, the jawline, the jaw angle, the chin.
You are actually restoring a lot of the structure and it has the effect that can be comparable
in many ways to a facelift.
So a strategy essentially is, you’re looking at is something to tighten the skin relative
to the underlying structure versus adding volume to the structure and restoring some
of that support.
Now of course, there are many ways to improve skin elasticity up to a certain limit.
And the challenge I find in my practice is of course helping patients get the best value
for their investment in resources and time.
A lot of times, people look to try to get tightening of their skin and even if you get
the skin a little bit tighter through a non-surgical approach whether it’s a radiofrequency or
laser device, if it doesn’t tighten that significantly and the before and after is not that dramatic,
well it’s hard to justify that.
So I find myself gravitating towards restoring volume more than trying to tighten the skin.
And again, it’s always customized on an individual basis.
Everyone comes with different anatomy, skin types, history such as cigarette smoking,
sun exposure, etc.
There really is a customization necessary for every individual case.
And then we have to figure out what is the most practical.
So learn about these options such as Structural Volumizing.
I think that a full facial evaluation is necessary.
A physical examination is necessary but I think there is certainly an opportunity.
And also, don’t forget about looking at your own posture and seeing if there is any potential
benefit there and I suspect, you might find some use in that little pearl.
So I hope that was helpful, I wish you the best of luck and thank you for your question.