25 August 2020
For harmless rolls of fat tissue, double chins get an undue amount of flack. Even the queens of selfies, the Kardashian clan aren’t spared from their unsightly neck bulges. Khloe Kardashian famously declared “say no to double chin vibes” with the solution: stick your chin out. Amy Schumer too, gave her double chin a euphemism in her unabashedly self-deprecating manner- the “at risk chin” and shared that if she did not keep her “at risk chin” above sea level, it would double in appearance.
If only it were that easy to do, keeping our chins up and out 24/7 to hide our double chin.
Or perhaps, you could celebrate your double chin like Chinventures; Michelle Liu’s antithesis to Khloe’s perfectly posed photos with her selfies from angles so unflattering, Khloe would be disowned from the Kardashian family.
Where chins are concerned, we know that two (or three) is not better than one. Can losing weight and exercise get rid of a double chin? Why do I have a double chin even though I am not overweight? Read on as I explore the topic of double chins, the common FAQs and the non-surgical treatments for double chins.
Amy Schumer wasn’t just being self deprecating when she coined the term “at risk chin”. The double chin is due to fat tissue under the chin and is known in medical terms as submental fat. These fat tissue in double chins are not life threatening, but have been associated with difficult airways to intubate in times of surgery.
Why exactly are submental fat and double chins so damning? Because of its obvious position under the chin, fats and droops are obvious. Double chins distort the crisp neck-jaw distinction (cervicomental angle) and the sharp jawline that are universally regarded as markers of youth and beauty.
There are 3 main causes that explain why you have prominent submental fat/ double chin
1. Aging causing double chin
Skin loses collagen and elastin as we age. Collagen and elastin are needed by skin to retain its support and tautness and therefore skin becomes lax and saggy over time. Muscles also atrophy and this leads to additional loss of support of tissues under the chin. Submental fat also loses its support and sags with age. As a result, the abundance and sagging of tissues in the chin blunts the once defined cervicomental angle and jawline, causing the double chin.
2. Genetic predisposition and double chin
Evidence has shown that double chins are more common in families, suggesting a genetic predisposition to double chins. This also explains why some slim patients and people who diet and exercise regularly do not succeed in losing their double chins.
3. Body weight and double chins
Contrary to popular belief, double chins can occur regardless of your body mass. This means that being slimmer does not confer immunity to those dreaded neck rolls. However, having a greater body mass puts you at risk of developing a double chin by having more fat deposition around your face.
Double chins are notoriously difficult to treat. In the past, the solutions boiled down to two choices- (1) cut it out (excision surgery) or; (2) suck it up (liposuction or living with it). And perhaps that explains with the advent of modern non-invasive treatments for double chin removal, especially with the non-surgical fat elimination drug, Kybella receiving the US FDA approval in 2015, people are increasingly turning to non-surgical treatment for double chin removal.
1) Neck threadlifts 2) Kybella (or Belkyra)/ Mesotherapy 3) Cryolipolysis 4) High Intensity Focused Ultrasound (HIFU)
How can neck threadlifts treat double chin?
I’ve covered what a thread lift is in this post (here). Thread lifts do more than augment the nose or lift saggy skin and is emerging in popularity for its immediate results when it comes to treating double chins.
Essentially, very fine, dissolvable surgical threads are placed is placed under the chin to life the submental fats under the chin. My preference of threads for thread lifts is the Silhouette Soft threads for thread lifts of the double chin and neck. I’ll explain why below.
This is what a Silhouette Soft thread looks like magnified: fine thread with tiny cones to anchor the soft tissue for additional stability.
Silhouette Soft threads are made up of a dissolvable material called Poly-L-Lactic acid and consist of tiny cones. These threads act as a scaffold to lift the double chin fat and skin and the cones then anchor the threads in place. Over time, as the threads and cone dissolve under the double chin, the threads and cones also stimulate the submental area to produce collagen for progressive replacement of collagen loss with age. This gives the additional benefit of gradual lifting and tightening of skin in the double chin area.
How many threads will I need for the double chin in a thread lift?
Sihouette Soft thread lift typically requires less threads.
2-3 threads for Silhouette Soft thread lift; this is why I prefer to use Silhouette Soft for double chin thread lifts compared to the conventional Korean threads (e.g. Ultra V) which usually number more than 20 for the double chin. I do also use Korean threads for thread lifts of the face and nose; but for the double chin, I find that the Silhouette Soft threads in the double chin give better results with a much smaller number of threads- this translates into cost savings and less recovery time and swelling for my patients.
How is the double chin thread lift performed?
Numbing cream is applied to the double chin for at least 20 minutes.
Local anaesthesia is injected into selected points of the double chin to minimise pain.
Markings are made prior to starting. Here, local anaesthesia is being injected at where the threads exit. This isn’t bleeding; my skin marker happens to be red.
A small needle is used to create a small entry point to pass the threads through the double chin. This needle is then removed.
A needle is used to create a small hole or entry point for the threads to pass through.
The threads are passed through the double chin and the ends are then cut. I design the vector of the thread lift such that there is a bidirectional pull for even greater results.
The thread is being passed through the double chin.
The thread is also passed through the double chin on the opposite site. You can see that the thread has exited on the left side of the double chin.
· Non-surgical · No incisions/cuts/scars · Immediate results · Progressive collagen replacement · Natural looking results
Yes, thread lifts are safe in the hands of an experienced doctor. For more information on thread lifts, please read my post on thread lifts here.
What is Kybella or Belkyra ?
Perhaps the most exciting and anticipated advancement in mesotherapy medicine for double chin treatment is Kybella (sodium deoxycholate or ATX-101). Kybella is known as Belkyra in Singapore. Kybella or Belkyra is a medication that dissolves fat and is the only US FDA approved non-surgical treatment for submental fat. When injected into submental fat, Kybella or Belkyra has dual effects:-
Kybella (or Belkyra) works by destroying fat cells in the chin (submental area) to reduce the double chin via 2 mechanisms:
1) Removal of fat cells- Kybella or Belkyra causes the membrane of the fat cells to be dissolved and this leads to death of the fat cells. These destroyed fat cells are gradually removed through natural body processes
2) New collagen formation-by recruiting cells called fibroblasts in the skin.
With reduction of fat deposits under the chin and tightening of the skin, the bulge of the double chin is reduced with improved appearance of the cervicomental angle. Kybella or Belkyra is also one of the most popular ways of double chin treatment in the US.
Update Aug 2020: You can read more about the controversies surrounding Mesotherapy in this blogpost Why Are Mesotherapy Fat Dissolving Injections Banned in Singapore?
How is Kybella or Belkyra administered?
Kybella or Belkyra is injected directly into the double chin. Injections are spaced approximately 1cm apart. The number of injections will depend on the size of your double chin.
How soon can I see results after injection of Kybella or Belkyra?
As soon as 2 weeks after injection of Kybella into the double chin. Reports have also shown that results become more obvious from the second session onwards.
How many sessions of Kybella or Belkyra will I need for my double chin?
2-6 sessions are required for most people to obtain obvious results.
What are the side effects of Kybella or Belkyra injection into the double chin?
Temporary redness, swelling and bruising are common reactions for a few days to a week after Kybella injections. Rare complications include paresis of a nerve that runs on the sides of the jaw called the marginal mandibular nerve.
Any risk of recurrence?
The removal of fat cells from the double chin by Kybella or Belkyra is permanent. However, new fat cells can be deposited into the double chin because of weight gain and aging.
Where can I get Kybella?
Even though Kybella (or Belkyra in Singapore) is US FDA approved, the use of Kybella and mesotherapy are not permitted by Singapore’s Ministry of Health. The next best alternative is thread lifts (see below).
Cryolipolysis or fat freezing is another US FDA approved non-invasive treatment for submental fat in the double chin. Cold temperature freezes the fat cells to destroy them in the double chin before the fat cells are excreted. Based on efficacy and safety, Coolsculpt is a fat freezing device that received US FDA clearance for double chin removal in 2017.
As the name suggests, non-invasive cooling is applied to the double chin area to destroy only the fat cells while leaving the skin and the rest of the surrounding tissues intact. These fat cells in the double chin are then cleared by our body’s natural processes. The cold temperature also numbs the skin of the double chin, so discomfort is minimised.
How many sessions of double chin fat freezing/cryolipolysis will I need?
Cryolipolysis with CoolSculpt’s Cool Mini for double chin with the device placed at the submental area.
Results can be seen after 1-2 sessions of double chin fat freezing/cryolipolysis. Patients with more submental fat will require more than 2 sessions for optimal results.
How soon can I see results after double chin fat freezing/cryolipolysis?
4-6 weeks after each session of double chin fat freezing/cryolipolysis.
Are there side effects to double chin fat freezing/ cryolipolysis?
Common side effects of fat freezing/ cryolipolysis of the double chin are temporary bruising, swelling, numbness and tingling in the chin.
HIFU is non-invasive ultrasound procedure that lifts and tightens skin around the double chin area to reduce the appearance of the double chin.
Ultrasound waves are passed through the skin to target deeper tissues at different depths- 1.5mm, 3.0mm and 4.5mm to create a lifting and tightening effect. HIFU also has mild fat melting benefits and this makes HIFU a good combination treatment with Kybella or Belkyra and cryolipolysis/Coolsculpt.
Examples of HIFU devices are Ulthera, Lifthera and Sygmalift.
• Neck creams
• Dieting and exercise- they can cause weight loss but this is not targeted at the submental fat.
And that’s it for double chins! In summary, double chins are caused mainly by aging, genetics and weight. In Singapore, Kybella or Belkyra for double chin treatment is not approved by the Ministry of Health even though it has received US-FDA approval. Hopefully, Kybella or Belkyra will be approved in Singapore soon because Kybella or Belkyra has been proven to be effective for removal of double chin. However, there are also other effective ways of double chin treatment in Singapore- namely thread lifts, fat freezing/cryolipolysis and HIFU. These are also safe and effective treatments with their own pros and cons just like Kybella .
I hope that this post clears the air with some of the confusion surrounding double chins. Feel free to leave me a message or comment if you have any queries!