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Submental Fullness: Etiologies, Anatomy & Treatments

Submental fullness is a common complaint in males and females that often presents a therapeutic challenge.  The submentum can be defined as the area located under the chin in the midline of the neck above the prominence of the thyroid cartilage, or the so-called “Adam’s Apple.  When fatty collections occur within the submentum and adjacent spaces, patients lose their youthful and aesthetically pleasing neck that they remember having in their 20s and 30s.  

Submental fat accumulations obscure the well-defined mandibular outline, blunt the normal curvature of the cervico-mental angle of 105° - 120°, and camouflage the visible anterior borders of the sternocleidomastoid muscle, subtle hollows of the subhyoid cartilage depression, slight prominence of the thyroid cartilage.  Accumulations of submental fat may be localized in the subcutaneous fat compartment between the skin and platysmal neck muscles and/or under the platysmal muscles in the submuscular compartments.  Fat in these compartments are stubbornly deposited, oftentimes unresponsive to diet and exercise alone.  

Neck fullness from fat accumulations can be due to a number of factors, that include, but not limited, to genetic factors, hormonal changes, lifestyle imbalances and aging.   Occasionally, factors other than fatty deposits can amplify an overweight and aged appearance.  These discrepancies include an overly-projected nasal profile, an under-projected chin (retrognathia), or a low/anterior hyoid cartilage position, and finally skin and muscle laxity/spasticity ─ all of which contribute to full neck appearance, furthering disharmony to the aesthetic neck.  

Solutions to treat the complexity of neck aging require an in-depth knowledge of the local anatomy that allows the plastic surgeon to safely and effectively address the patient’s aesthetic concerns.  For example, excessive skin or muscle laxity may be address by surgical neck lifting or amenable to non-surgical approaches for milder degrees of skin laxity with ultrasound energy (Ultherapy®) or radiofrequency energy (INTRAcel™).  Spastic and prominent medial platysmal bands (turkey neck) can be treated with a surgical platysmaplasty, neuromuscular blockers (Botox®), or with combination therapies.  Excessive subcutaneous fat may be more effectively treated with liposuction while lesser and more localized accumulations may be managed with Kybella® (FDA-approved) or by CoolMini Sculpting ZELTIQ™ (FDA-approved).  Excess submental fat beneath the separated platysmal muscle bands is more appropriately managed with a surgical lipectomy rather than by Kybella® or CoolScupting™ techniques because of their depth and presence of functional nerves and vessels.  Prominent and drooping nasal profiles are best attended to with an anatomical rhinoplasty.  Retrognathism can be effectively and permanently corrected with chin augmentation using implants.   

In summary, surgical approaches are safe and effective for patients with significant neck deformities (fat fullness, skin/muscle laxity).  However, surgical management may not be for every patient.  Non-invasive approaches are a relatively new but commonly sought-after for patients who present with lesser findings, are not ready for surgery, or have significant medical problems.  It is important when planning therapy to be mindful that non-invasive techniques may require multiple/serial treatments, which can come at significant patient cost and time.  Dr. Sasaki and his specialized staff in the Advanced Surgical Center and Injectable Device Center are able to clarify all of these approaches, review side-effects and complications, and provide you with a realistic expectation of your outcome in a thoughtful and personalized manner to ensure your satisfaction and safety.

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