Journal of JDC

Dermatology & Cosmetology
Volume 1 Issue 1 - 2016
Addressing the “Double Chin:” Trends in Submental Contouring
Amit Bhojwani*
Department of Otolaryngology-Facial Plastic Surgery, Rowan University, USA
Received: September 21, 2016 | Published: October 05, 2016
*Corresponding author: Amit Bhojwani, Department of Otolaryngology-Facial Plastic Surgery, Rowan University, USA, Email:
Citation: Bhojwani A (2016) Addressing the “Double Chin:” Trends in Submental Contouring. J Dermat Cosmetol 1(1): 00002. DOI: 10.15406/jdc.2016.01.00002


The dreaded “double chin” is a result of excess submental fat. This appearance is often psychologically dissatisfying to patients and as such, they seek consultation to adjust their submental profile to a more aesthetically pleasing one [1,2]. A recent survey of patients demonstrated that 77% of patients presenting to their dermatologist or plastic surgeon were concerned about submental fat, and 61% of patients wanted it reduced.1Bothsurgical and non-invasive options are available; however, finding the right approach is of the utmost importance to yield the best possible outcome. Often times, multiple modalities are used to address the various components of the aging face. Injectable fillers, liposuction, laser lipolysis, and a host of other methodologies can be combined to rejuvenate the face [3].

Liposuction is commonly used to address submental fullness. This method, however, is dependent on the quality of the patient’s skin. Injury to the marginal mandibular nerve as well as over suctioning of the fat can lead to contour irregularities. Additionally, isolated submental liposuction may not address submental fullness and the aging face fully; thus, a cervicoplasty consisting of an open liposuction and platysmaplasty is considered superior [4,5]. Laser lipolysis is often performed with liposuction to achieve facial rejuvenation. The Nd: YAG or CO2 laser may be used by selecting single or multiple wavelengths to target the submental fat. Because of the unfavorable side effect profile associated with the thermal damage induced by the laser, this modality is not popular amongst aesthetic surgeons. Moreover, the surgeon must be careful not to damage the marginal mandibular nerve [6,7].

Microfocused ultrasound is a method that delivers mechanical energy to disrupt the adipocytes. Using a non thermal, lower frequency setting increases patient tolerability. This method targets the dermis and can be used in all skin types safely to achieve skin tightening. In contrast, using higher-frequency ultrasound is far more painful and intolerable for most patients [8,9].

Monopolar, bipolar, or unipolar radiofrequency devices may be used to deliver heat in a selective fashion to the submental fat. The radiofrequency mode used determines the penetration depth. Unlike higher-frequency ultrasound, which may produce longer periods of downtime, radiofrequency use results in virtually no downtime, and transient side effects have been reported [10-12]. Cryolipolysis, a non-invasive modality, has recently received FDA approval in the use of submental fat treatment. This technique is based on the supposition that adipocytes, which are more prone to cooling than other skin cells, are cooled such that apoptosis is triggered. Moreover, inflammation begins a cascade that leads to macrophage digestion of the fat [13]. Prior to FDA approval, a study by Kilmer et al. followed 60 patients with complaints of excess submental fat. These subjects were treated with the Cool Mini applicator and followed for 12 weeks. At the time of their survey, 83% of subjects were satisfied, 77% reported visible fat reduction, 77% felt that their appearance improved following the treatment, and 76% found the procedure to be comfortable. No adverse events from the treatment were noted [14]. Intriguingly, although the procedure is well tolerated and safe, there has been a recent report of paradoxical adipocyte hyperplasia as a delayed side effect. In such a case, liposuction treatment of the affected region may be required [15].

An extension of injectable fillers has recently been approved for the chin with the advent of ATX-101 or deoxycholic acid. The mechanism of action of this injection is through its bile acid properties of emulsifying and solubilising fat. The product promotes adipocyte lysis through disruption of the cell membrane [16,17]. The REFINE-1 and REFINE-2 studies demonstrated that ATX-101 significantly reduced submental fat in comparison to placebo. Furthermore, patients reported a high level of self-perceived improvement after the treatment [18]. The product was generally well-tolerated with few patients reporting adverse events [16,18].

Excess submental fat may make the patient appear overweight and/or older. As a result, these patients seek treatment to address their displeasing “double chin.” Many modalities are at the disposal of the surgeon to address the patient’s complaint, and at times, these techniques may be combined to achieve the optimal result for the patient. Through these methods described herein, the patient is able to obtain a stronger appearing chin that increases self-confidence. Two newer techniques, crypolipolysis, and the injectable fat-dissolving product, ATX-101, demonstrate promising results for these patients.


  1. Schlessinger J, Weiss SR, Jewell M, et al. (2013) Perceptions and practices in submental fat treatment: a survey of physicians and patients. Skinmed 11(1): 27-31.
  2. (2014) Cosmetic Surgery National Data Bank statistics. Aesthet Surg J 34 Suppl 1: 1-20.
  3. Vanaman M, Fabi SG, Cox SE (2016) Neck Rejuvenation Using a Combination Approach: Our Experience and a Review of the Literature. Dermatol Surg 42 Suppl 2: S94-S100.
  4. Fattahi T (2012) Submental liposuction versus formal cervicoplasty: which one to choose? J Oral Maxillofac Surg 70(12):  2854-2858.
  5. Gentile RD (2005) Purse-string platysmaplasty: the third dimension for neck contouring. Facial Plast Surg 21(4): 296-303.
  6. Sarnoff DS (2013) Evaluation of the safety and efficacy of a novel 1440nm Nd:YAG laser for neck contouring and skin tightening without liposuction. J Drugs Dermatol 12(12): 1382-1388.
  7. Jianu DM, Filipescu M, Jianu SA, Nita AC, Chirita DA (2012) The sinergy between lasers and adipose surgery in face and neck rejuvenation: a new approach from personal experience. Laser Ther 21(3): 215-222.
  8. Jalian HR, Avram MM (2012) Body contouring: the skinny on noninvasive fat removal. Semin Cutan Med Surg 31(2): 121-125.
  9. Gutowski KA (2016) Microfocused Ultrasound for Skin Tightening. Clin Plast Surg 43(3): 577-582.
  10. Weiss RA (2013) Noninvasive radio frequency for skin tightening and body contouring. Semin Cutan Med Surg 32(1): 9-17.
  11. Carruthers J, Fabi S, Weiss R (2014) Monopolar radiofrequency for skin tightening: our experience and a review of the literature. Dermatol Surg 40 Suppl 12: S168-173.
  12. Park JH, Kim JI, Park HJ, Kim WS (2016) Evaluation of safety and efficacy of noninvasive radiofrequency technology for submental rejuvenation. Lasers Med Sci  [Epub ahead of print].
  13. Krueger N, Mai SV, Luebberding S, Sadick NS (2014) Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. Clin Cosmet Investig Dermatol 7: 201-205.
  14. Kilmer SL, Burns AJ, Zelickson BD (2016) Safety and efficacy of cryolipolysis for non-invasive reduction of submental fat. Lasers Surg Med 48(1): 3-13.
  15. Jalian HR, Avram MM, Garibyan L, Mihm MC, Anderson RR (2014) Paradoxical adipose hyperplasia after cryolipolysis. JAMA Dermatol 150(3): 317-319.
  16. Ascher B, Hoffmann K, Walker P, Lippert S, Wollina U, et al. (2014) Efficacy, patient-reported outcomes and safety profile of ATX-101 (deoxycholic acid), an injectable drug for the reduction of unwanted submental fat: results from a phase III, randomized, placebo-controlled study. J Eur Acad Dermatol Venereol 28(12): 1707-1715.
  17. Ascher B, Fellmann J, Monheit G (2016) ATX-101 (deoxycholic acid injection) for reduction of submental fat. Expert Rev Clin Pharmacol 9(9): 1131-1143.
  18. Jones DH, Carruthers J, Joseph JH, et al. (2016) REFINE-1, a Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase 3 Trial With ATX-101, an Injectable Drug for Submental Fat Reduction. Dermatol Surg 42(1): 38-49.
© 2014-2018 MedCrave Group, All rights reserved. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use.
Creative Commons License Open Access by MedCrave Group is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at
Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version | Opera |Privacy Policy