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Blepharoplasty Lady

PST 011: Double Chin — Read the Transcript

May 7, 2018

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Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica.

Hello, Dr. Stephen Mulholland here in Toronto, Canada with Plastic Surgery Talk. We have a new podcast episode on double chins, the management of the waddle, the turkey neck. How to do it surgically and non-surgically, that’s what we’re talking about today. So what is a double chin first of all? It’s excess fat under the skin under your chin, above the muscle but under the skin. Two ways you get a double chin. Number one, you put on a little more weight than you want, so weight gain. Sometimes it goes to the tummy, the love handles, the out or inner thigh, the bra line, or the arms. Sometimes it also goes to the chin and gives you that oblique neck, the loss of the angle. So first option if it’s weight responsive double chin is to lose weight. However, patients can’t lose weight and they’ve tried or they lose weight off their tummy, their hips but won’t come off the neck. Then you may need intervention, which is our podcast topic for today.

The other kind of double chin is the hereditary double chin. You got it ’cause your parents got it and you’re relatively in shape, and within your ideal body weight elsewhere, but you have an oblique neck with a waddly excess, sort of a waddle under the chin of subcutaneous fat. That’s a genetic curse and again, all the exercise in the world won’t target that. That’s why we’ve developed some really cool stuff, some really neat new stuff to treat double chins non-surgically.

So a lot of patients with double chins will see me and say, “Doc, I work out. I diet, exercise. I’m in the gym all the time. I’m seeing some results on my chest or my tummy or my thighs, but I can’t get to this little bit of fat under my chin. And that’s because it’s the most resistant to diet and exercise, especially if it’s a hereditary curse. You may be within your ideal body weight, but you still have a double chin. So sometimes exercise and diet will not get at this and that’s where it comes to plastic surgeons and aesthetic physicians. We have tools and tactics to get rid of the double chin, double chin blasters and busters without surgery, and you don’t need to diet and exercise ’cause we can target it with our treatments.

Okay. So you’re sitting back, listening to this podcast with a double chin. What are your options? What are the best solutions for a double chin? Well usually surgery’s going to be a very good option, but it comes with an incision, scalpel based treatment, recovery. But we can usually make a pretty good result. So a waddle lift, a submental lift, a mini lift of the neck is usually the best option, but it’s the least attractive because it comes with a week of down time, scars and surgery. So what are the best non-invasive, non-excisional, minimally invasive options? Well two of them. Number one … really three, we can treat with a chemical. We inject the double chin with a chemical that breaks down fat, and that chemical is called Kybella in the United States or Belkyra in Canada and internationally. And it’s a chemical that’s safe, it’s a pharmaceutical agent that’s called deoxycholate and it is lecithin. It is a chemical that we produce in our body by the gall bladder. So when you have a McDonald’s french fry and you chew it, you swallow it into your stomach, your brain knows it has some fatty acids to break down and it releases from the gall bladder this deoxycholate, which breaks down fats that come through your stomach into the small intestine.

So deoxycholate, a natural breakdown product for fat and we inject it directly into your fat and so it’s a simple treatment, takes all of 10 or 15 minutes to do. We inject directly into the waddle and then the waddle gets a little firm, a little hard, a little sort of frog necked for two or three weeks. But there’s no bruising, very little down time and by the sixth week, you’ve lost a significant amount of that under the chin fat, then you come back, see your physician and we usually do it one more time. So it’s two treatments, six weeks apart. You get about 50% of the waddle to reduce and diminish. The kicker is you have to have pretty good skin tone ’cause you don’t get a lot of skin contraction with deoxycholate injections. So if you got loose skin and a waddle or a double chin, a waddly type neck that may lead to loose skin, Belkyra or Kybella may not be your best option.

Option number two is treating the submentum or the double chin with energy. You strap on something on your chin, we treat it from the outside with cooling (which would be CoolSculpt submental) and we expose that fat to five degrees Celsius for about 45 minutes to an hour, and we can kill about 20 to 25% of the fat. We do another session six weeks later just like Kybella to kill an additional amount. So a nice reduction with cooling or I can use another device here at SpaMedica called SculpSure submentum or the BodyFX mini. The SculpSure is a laser heating device, so CoolSculpt is cooling, SculpSure is heating and BodyFX is a device that we treat the under neck with electroporation and radio frequency current. All three of those devices work and sometimes we mix them up in a little protocol over eight to 12 weeks. So again just like Kybella, which is two treatments, six weeks apart and then wait six weeks after the second treatment. It’s about a 12 week program. These energy based devices, CoolSculpt, SculpSure, BodyFX mini where we treat the submentum is about an eight to 12 week program. Again, we can reduce about 50% of the fat and this time, especially with SculpSure and BodyFX mini, we get skin tightening.

So the last option and usually the most effective of the minimally invasives, is that I put some freezing in the neck. I put in a device under the chin and in the chin fat directly, so we don’t heat through the skin, we heat directly in the fat and it’s called FaceTite. It uses radio frequency energy directly deposited into the fat with a small probe. It melts the fat ’cause it heats that frozen fat to about 70 degrees, which you don’t feel ’cause it’s under local anesthesia and then we remove the liquified fat. So it’s gone immediately. There’s no waiting six weeks or 12 weeks and because the skin is heated from the inside out, it’s almost like hamburger meat on a barbecue grill. At 70 degrees, it’ll shrink about 25%. So we use the heat from the FaceTite to shrink the skin, melt the fat and then I’ll remove it. It takes one hour and your double chin is gone, but you have to be brave enough to have a minimally invasive procedure. You need about four or five days off with a wrap and some swelling, but it’s gone immediately. So there are your options, Kybella, CoolSculpt, SculpSure, BodyFX mini or modern versions of submental lipo called FaceTite. Those are your options in 2018. You have a lot of choices on getting rid of your double chin, but get rid of it, we can.

Okay. Let’s say you do one of those treatments, CoolSculpt, BodyFX mini, SculpSure, Kybella. You do the treatment and the fat gets melted and your double chin is gone, but it’s replaced with skin laxity, kinda wiggly, jiggly, skinny turkey neck. What do you do then? Well that’s one of the complications of one of those non-excisional, non-invasive treatments, is the skin tone may be compromised. And so if it’s a bit of a surprise and the physician didn’t predict this, now you gotta do something for the loose skin. And we have some treatments where we can do under the skin heating with a radio frequency probe called FaceTite and we can do little mini lifts behind the ear. And so I can do a little incision behind the ear, take the loose skin of the neck and pull and tuck it behind the ear, so no visible scars. So mini lifting with the behind the ear scars can give a nice tight skin result, when you have that unfortunate side effect of the treatments we discussed, where you kill the fat, but you have loose skin.

Now what if you have loose skin right out of the gate? You come in with a little bit of fat and loose skin, or no fat and you have that kind of iguana skin, that loose tricky neck. Well Kybella, CoolSculpt, SculpSure, BodyFX mini are not good options. They kill fat, they don’t tighten skin significantly. Now you need to go right to a mini surgery, which is a combination of FaceTite, fractional radio frequency energy on your skin and then lifting that skin and tucking it behind the ear. A behind the ear mini lift, which can be under the local anesthesia, takes about an hour and a half to two hours to do, you need one week off, but you get a very nice mini neck lift with almost no investment in time, recovery or risk. Generally heals very well. And so that’s what I offer patients with very loose skin of the neck, either as they present or the unfortunate circumstances where they might’ve gone to a treatment center that left loose skin after their energy based treatments, their Kybella. And now they have something that’s even worse, which is old skin without fat. And so the surgical option is a behind the ear mini lift. It’s under local anesthesia, relatively simple to do and it’ll last about a decade.

What about the front of the neck if it’s got little lines and droopy skin? We’ve got very technology now, what are called fractional laser and energy devices, or a fractional needle based treatment or a fractional laser. It can be used to treat loose, wrinkly skin at the base of a neck to get enhanced tightening. And so there’s many problems of the neck. We often think of, “Oh, I’ve got a double chin.” But you may have double chin and good skin, double chin and compromised skin and you need to see a medical office that offers all solutions for all types of necks that might present. The double chin has never been easier to treat, but you gotta diagnose the underlying skin tone to get the best possible result.

Thanks for joining us again. Dr. Stephen Mulholland here in Toronto, Canada with Plastic Surgery Talk. We’ve really, really dove into the double chin and management of the double chin, as you can see lots of interesting options. If you found this informative and entertaining, please share this podcast on all your social channels and we look forward to seeing you here next time.

Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
has been practicing plastic surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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