Tried Lipo & Thread Lifts on Your Double Chin But Nothing Changed?

Hello, I'm Dr. Youngkee You, a board-certified plastic surgeon.

Many people have had double-chin liposuction or thread lifts for a sagging neck, jowls, or vertical neck bands. If you still feel "nothing really changed," this post may help.

In facelift surgery I work in the deep plane(딥 플레인) of the SMAS(스마스) layer, and go a step further with the extended deep plane(확장 딥 플레인) technique. It's demanding, but the difference in results is clear. I also place the incision along each patient's own anatomy rather than by bony landmarks, lifting the SMAS like fitting puzzle pieces — naturally filling deficient volume in the process.

A patient with severe sagging

Sagging of the face, the neck, and the brows were all severe. First, the pre-op photos.

Front

45°

Side

Bulging under-eye fat with a deep tear trough(눈물고랑) beneath it, deep nasolabial and marionette lines, sagging cheeks and jowls(심술보), several vertical neck bands, and a jaw–neck boundary that had almost disappeared — an unusually difficult case.

"Can liposuction fix this?" — My answer is always the same

It's the first question most people with this kind of neck sagging ask. My answer is unchanging: "Liposuction won't make a big difference."

Then they usually ask, "What about platysma tightening?", showing me a dramatic before-and-after ad. I ask back: "Where, and through how large an incision?" Most were told 0.5 cm or less, in the middle of the chin. But that length cannot provide the visual field needed to tighten the platysma(활경근) muscle. I can say this with certainty — it's not possible.

For reference, I harvest costal cartilage(자가늑연골) through just 1.1 cm (the usual is 2.5–5 cm), and a mini-facelift through 2.0 cm. Even so, for submental sculpting(이중턱 조각술) I make at least a 2.5 cm incision — that's what it takes to see properly. (The incision sits in the natural crease that appears when you lower your chin, so it's hard to notice.)

To truly reshape a double chin, you must address several layers

Tightening the muscle alone rarely produces the change seen in ads. The platysma is delicate — pull it too tight and it tears, and the effect doesn't last. An ideal jawline takes a combination of methods.

• Deep-layer fat: standard liposuction only removes fat outside the platysma. Deeper fat must be removed under direct vision through a 2.5 cm incision — that space holds many vessels, so the clustered fat has to be handled while watching closely.
• Submandibular gland(턱밑 침샘): if it has descended below the hyoid bone(설골), a partial resection is needed; otherwise the sides of the neck bulge into a "cobra neck." (It's small, and I've never seen a side effect from this.)
• Digastric muscle(턱두힘살근): if hypertrophied and bulging, it is trimmed slightly.
• A counter-intuitive tip: unless the patient is quite overweight, I rarely remove the outer-layer fat. It isn't the key to a dramatic jawline, and removing it often causes irregularities that are nearly impossible to rebuild later.

I state honest goals first

During the consultation I explain the realistic range of improvement, repeatedly.

• Nasolabial folds won't disappear, but will soften.
• Under-eye fat flattens, but saying a deep tear trough will vanish completely would be a lie — the shadow does ease, so the area looks much brighter.
• Horizontal neck lines are very hard to remove; vertical bands improve a lot.

If that degree of improvement would satisfy them, I recommend surgery; if not, I tell them not to rush, and to take time and get several more opinions.

The surgery, and the 5-week result

On the day that finally worked with a busy schedule, the following were done together:

Facelift (full face) · Neck lift · Submental sculpting · Lower blepharoplasty · Endoscopic forehead lift

This patient lives abroad and left the country soon after the critical recovery period. Returning to Korea wasn't easy, but I happened to visit that region to give a lecture and was able to check the 5-week result there. (This is why the pre-op and 5-week photos differ in background and lighting — re-shooting in the same room wasn't possible. The photos are published with the patient's prior consent.)

Before · Front

After · Front · 5 wks

Before · 45°

After · 45° · 5 wks

Before · Side

After · Side · 5 wks

• Facelift — lifts the mid-face, lower face and jawline
• Neck lift — improves vertical bands and removes excess neck skin
• Lower blepharoplasty — repositions under-eye fat and removes some loose skin
• Endoscopic forehead lift — returns drooping brows to their proper position

A closing note

Be more cautious with any consultation that guarantees "it'll all work out" or "every wrinkle will vanish." There is no perfect result. The same "neck lift" or "submental sculpting" yields completely different outcomes depending on which layers are addressed, and how.

— Youngkee You, M.D.