Q. I do not like the fullness underneath my chin.  When I look at my profile in the mirror or see pictures of myself from the side, I hate the way my neck looks.  I am only 40 years old and my neck has looked like this since I was in my 20’s.  How can I get rid of the fat under my chin?

A. There are basically three ways to reduce the fat under your chin.  The first is liposuction.  This is a very safe procedure that is time tested and can redefine your neck by reducing the fat under the chin, and if necessary, reduce the fat on either side of the neck.  For liposuction to be an option, a patient has to have good quality skin in the neck with enough elasticity to allow the skin to tighten up after the fat has been removed.  Good elasticity is important because you do not want to remove fat and be left with saggy skin in its place.  Liposuction of the neck is typically performed under anesthesia and is an outpatient procedure.  After the procedure, you must wear an elastic compression garment around the neck for a couple of weeks to help direct the skin during the tightening phase.
A second option to reduce fat is the use of a relatively new injection called Kybella.  Kybella is injected directly into the fat pad under the chin and the drug will melt a small percentage of the fat with each injection.  It can only be used directly under the chin and may not be injected on either side of the neck.  The most common side effect is bruising.  It does require multiple treatments to achieve the desired results. 
The third option is the use of Coolsculpting®.  Coolsculpting® is a proven technique for reducing fat in targeted areas, and the company has just received FDA clearance for its newest device that will freeze the fat under the chin.  Coolsculpting® under the chin works the same as it does in other areas of the body, it freezes a certain percentage of the fat causing it to die, which is then digested and removed from the treated site.  Like liposuction, good elasticity is best so that you are not left with saggy skin after the treatment.  Typically, it will take one or two treatments to achieve the desired results.  A consultation with a board certified plastic surgeon is the best way to determine which of these techniques is right for you. 

Q. I have heard some buzz about a new saline implant called the Ideal® implant, which I heard is more like a silicone gel implant in terms of softness.  I am considering a breast augmentation and do not know much about it.  What is it?

A. The Ideal® implant is a new addition to the family of breast implant options. It was FDA approved in 2014 and became commercially available in September 2015.  It is a totally redesigned saline implant that is more than just a “bag of salt water.”  Its design is a silicone shell within a silicone shell, within a silicone shell, within a fourth silicone shell. The advantage of this design is that it is softer than a standard saline implant and feels less like water and more like gel.  The more important advantage however, is that there is a significant decrease in the risk of wrinkling of the implant.  Wrinkling is the main disadvantage of the standard saline implant.  It is my experience that all standard saline implants wrinkle, and when placed in a thin woman with small breasts, the wrinkling may be visible or palpable on the skin surface. The Ideal® implant decreases this issue.
The surgery is performed in the same manner as a standard augmentation.  The incision is small (1.5 inches long) and is placed in the crease below the breast.  As a general rule, the implant is placed below the pectoralis muscle.  This implant is more expensive than the standard saline implant, and is slightly more expensive than the silicone gel implant.  I have used this implant and find it to be useful in many women who prefer a saline implant but are at risk for visible wrinkling with a standard saline implant.  Not all women will need the Ideal® implant, so a careful evaluation with multiple measurements of the breast dimensions will determine which implant is best for you.

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William Byron Barber II, M.D. has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery. He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com