TARGETING SUBMENTAL FAT
It eventually happens to most, if not all, of us. A tiny bit of extra fat starts to creep up under the chin. One day, it’s not there, and the next day, you can’t stop staring at it from the reflection of your iPhone. In some cases, the lateral edges of the jawline may become blunted as well, contributing to an aged or overweight look. There are several options for treatment of this small, but highly visible, region of the face:
Liposuction is a wonderful tool for targeting submental (beneath the chin) fat. The optimal candidates for liposuction are patients with good skin tone who have pockets of excess fat in localized regions. Fat cells which have been removed do not return, but the remaining fat cells will expand if the patient gains weight after surgery. In this procedure, a small (1 cm) incision is made in the crease immediately posterior to the chin. A small amount of fluid containing an intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (helps to contract blood vessels and limit blood loss), is injected. A narrow tube or cannula is then inserted and used to vacuum the fat layer deep beneath the skin. 2-3 small sutures are placed at the conclusion of the procedure, and a compression dressing for the chin is placed. Following the procedure patients typically notice a small amount of bruising and swelling, which resolves within one week. Other side effects include numbness of the area under the chin, which may last for several weeks. The sutures are removed one week later, and patients are asked to wear their compression dressing for another week at night. The procedure takes 30 minutes to perform in the office, and the final result is typically seen 3 months after surgery. Re-treatment is typically not necessary.
KYBELLA® is an FDA-approved injectable drug which targets submental fullness. Kybella° is made from deoxycholic acid, a naturally-occurring molecule in the body that aids in the breakdown and absorption of dietary fat. When injected into subcutaneous fat, KYBELLA® causes destruction of fat cells. During the procedure, a series of injections are made at the site of fullness below the chin. Patients may notice swelling and mild bruising at the site of injection. Results begin to be seen in 4 weeks. Most patients require 2-4 treatments for visible results. Each treatment session lasts for 15-20 minutes. Again, retreatment is typically not necessary once the desired results have been attained.
The CoolMini™ is the latest development from CoolSculpting®, which works on the principle of cryolipolysis. During treatment, a small applicator is applied below the chin and the tissue is precisely cooled. The fat cells beneath the skin are crystallized and then die, while the skin, blood vessels, and nerves are not affected. Over time, the body processes the fat and eliminates the dead cells. Approximately 20% of the treated area will be reduced. The procedure lasts one hour. Patients may notice mild swelling and bruising at the site which should resolve within 1-2 days. Results begin to be seen 4 weeks following treatment, and are most remarkable 2-4 months after treatment. In some cases, a second treatment is required to attain optimal results. Re-treatment should not be required after this point.
In some cases, patients have excess skin of the lower face or neck which are distorting the normal contour of the neck. In this case, non-invasive or minimally invasive techniques will provided limited results. For these patients, I recommend a lower facelift or necklift. This is a surgical procedure in which an incision is made in front of the ears and extended posteriorly to allow access to the neck. The deep tissues are tightened, and the excess skin is trimmed prior to being redraped and sutured. The procedure lasts 2 hours, and patients typically return home the same day with a private duty nurse. Bruising and swelling last for 4-5 days. Sutures are removed at 5 days after surgery, and patients may return to week 10 days after surgery. Strenuous exercise should be avoided for 2-3 weeks following surgery. While a lower facelift or necklift is a significantly more invasive procedure, the results are dramatic and immediate.
There are several options available for treatment of submental fat. The optimal method is determined not only by the patient’s anatomy, but also by his or her ability to undergo an invasive procedure. While less invasive procedures generally produce less dramatic results, they are still an excellent option for patients with small pockets of submental fat and good skin tone.