Treating a double chin

A genuine pocket of fat sitting under the chin, often present regardless of body weight and frequently genetic. People with this describe having had it since they were slim, and being unable to shift it with diet or exercise — which is accurate, because localised fat deposits do not respond to general weight loss in the way people expect.

This is what fat dissolving injections treat, and where they work well: a defined pocket, in someone at a stable weight, with reasonable skin elasticity.

Skin that has lost elasticity and now hangs, with little or no excess fat beneath it. Removing fat from beneath lax skin leaves the skin with even less to fill it, and the result is looser rather than tighter.

This is the case in which fat dissolving is actively the wrong treatment, and it is why assessment matters more than the price of the injection. Where laxity dominates, skin-quality treatment helps modestly and a surgical opinion is the honest answer for anything significant.

This one is not a fullness problem at all. A chin that sits back shortens the distance between chin and neck and creates the appearance of a double chin even where the tissue underneath is entirely normal.

Chin filler restoring projection improves this dramatically, often in a single appointment, and no amount of fat dissolving would have helped. It also improves the profile generally.

A meaningful proportion of people who come in asking about a double chin have this rather than a fat problem, and most of them are surprised. Looking at your own profile photograph — not a mirror — makes it obvious once it is pointed out.

In profile, at rest, and with the head in a neutral position rather than tipped. I look at how far the chin projects relative to the lip and nose, pinch the tissue to assess how much of the fullness is fat, and assess skin quality by how quickly it springs back.

Most people have a combination — some fat, some laxity, some projection issue — and the plan depends on which dominates. Where more than one applies, the order of treatment matters: restoring projection first often reduces how much else is needed.

Two to four sessions spaced four to six weeks apart is typical. The swelling afterwards is significant — under the chin it can be marked for several days, and the area will look worse before it looks better. That is the treatment working rather than a complication, but it needs planning around and I would not book it within a month of an event.

Fat cells broken down do not return, but remaining cells enlarge with weight gain, so a stable weight maintains the result.