Submental (Under Chin) Contouring: Neck Liposuction, CoolSculpting®, or KYBELLA®?

3 model progression of woman losing her double chin (models)

In this blog, I will cover the options to improve the contour of the submental area. First, though I will cover the confusing terminology describing this anatomy and the treatment options. At Aesthetica, we treat this area with the appropriate procedure—CoolSculpting, liposuction, a neck lift, or fillers.   

What Is the Submental Area?

What’s in a name? Is a rose a rose with any other name? 

There is some confusion about what the submental area is because most patients do not think of it as submental. They either call it their chin, their neck, or their double chin. But it is a distinct anatomical area that is actually under—thus the “sub” prefix—the chin or mentum. It is not strictly considered a part of the neck, but rather a part of the head—which is even more confusing. And to make matters even more complex, the area is between the chin and neck. Yikes. So when patients call and ask about chin liposuction—we know they actually are referring to the submental fat. 

What Causes Submental Puffiness?

It is important for patients to understand that sometimes the contour deformity is a smaller or receding chin and mandible. Or other times it is an anatomical variant called a low hyoid. With so many different anatomical situations, it is no wonder that patients are perplexed about what they are looking for—they first have to understand their own unique anatomy before they can progress to treatment options. 

To make this blog easier to understand, we are going to focus on the fat of the submental and side neck area to start and cover the three ways to remove fat.  After this, we will touch on the bony structure, and ways to address this. And finally, we’ll discuss the deeper structures and how they impact the entire contour of the submental and neck areas. 

How Do You Lose Submental Fat?

When there is submental fat (with or without side neck fat), the treatment options are KYBELLA®, CoolScultping, and liposuction. These three methods all permanently remove the fat. 


A KYBELLA treatment is an injection of an acid that destroys fat cells through an inflammatory process. The injections cause massive swelling that can last 1 to 2 weeks, and then the dead fat cells are absorbed by the body, resulting in a smaller amount of fat there and thus a smaller pinch of fat. The biggest downside with this treatment is the massive swelling. As it already is a body part the patient is self-conscious about, making it massively larger for a number of weeks is an issue. The other downside is that it takes a number of consecutive treatments, about a month apart, so it is swollen again and again and again. I no longer offer KYBELLA at my office for the submental area due to this issue, and instead offer both CoolSculpting and submental liposuction. This sometimes can be a difficult decision to make, because they both do work.  


Let’s cover the process of CoolSculpting first. This is the method in which the fat cells are frozen to the point in which they die, and the body flushes out the by-products in the urine. It is important to keep in mind that this is a process that takes time, so repeat treatments are scheduled 4 to 6 weeks apart. The submental area usually takes between 2 and 4 treatments to reach the desired goal, depending on the amount of fat that is present.

  • The Treatment: The first 2 treatments are done in a single session. The applicator is placed diagonally under the chin on one side and then the other so that the middle section overlaps and receives a double amount of freezing. While a patient is getting this treatment, which takes about 35 to 45 minutes, they can be reading, sleeping, watching TV, scrolling cat videos, or doing any other activity in which they keep their head still so the applicator does not pop off. When the applicator is first applied it does feel cold, but then there is no discomfort.
  • After the Treatment: The area will be sore but not too swollen, and the patient can resume normal daily activities. About a month to 6 weeks later, if a  second treatment session is desired, to remove even more fat, then it can be done.
  • Cost: The cost for this treatment is about $2500 to $3500 depending on the number of treatments. 
  • Benefits: The best thing about CoolSculpting is that it works and it is NOT a surgical procedure. That fact gives a lot of people comfort when they really do not want to have surgery. The patients who are the best suited for this have a small amount of submental fat—about an inch pinch just in the submental area.


When the fat extends around the side neck toward the earlobe and along the underside of the mandible or lower jaw bone, then it is usually better to consider liposuction. Liposuction of the submental area (with or without the side neck) is a surgical procedure.

  • The Treatment: The procedure requires the area to be numbed up with a local anesthetic, and then the fat is suctioned out with small tubes called cannulas. To make the patient comfortable during this, we use twilight anesthesia with an oral valium. The actual procedure takes about an hour.
  • After the Treatment: You are sent home with an ACE wrap on; this helps with the swelling and is required to stay on for the first 5 to 7 days. So while the liposuction is a “one and done” situation, there is more recuperation time that has to be factored in and time off requested depending on your job. 
  • Benefits: After the lipo, the contour is immediately better and continues to improve as the swelling resolves over 6 weeks. It does take 6 months for the final result and for the skin to shink as much as it is going to shrink. You can see the difference submental liposuction makes in my patients’ before and after photos below:
Neck Surgery Case 46 Before & After View #2 | Columbus, OH | Aesthetica Surgery & Spa
Before & After Submental Liposuction
Neck Surgery Case 55 Before & After View #2 | Columbus, OH | Aesthetica Surgery & Spa
Before & After Submental Liposuction

Will I Have Loose Skin After Submental Liposuction?

For patients with a large amount of submental and neck fat, the next question is whether or not the skin will need a tuck after the lipo. It is impossible to predict perfectly, but in general, the more fat that is removed, the looser the skin will be. And as we all age, the elasticity diminishes. So the older the patient, the less it will shrink as well. This is a discussion for patients over the age of 40—often it is better to do the lipo and neck lift at the same time to get the best contour.  

The older the patient, the more likely they will need the procedure to tighten the skin and the muscle underneath, and while I am at it, we do the jowls and cheeks. This is a procedure we call the Smartlift; you can learn more about it in our related blog post and the video below:

How Do You Fix a Receding Chin?

I finally want to cover the issue that is a small jaw or receding chin. These patients are actually calling about their chins! This can be improved with both fillers and a surgical implant, and I do both. Often we will use the filler for the first step to help the patient visualize the contour they desire. It is easy to do with chin fillers, but the results are only temporary. Once we have determined the amount of chin projection desired, we discuss adding a chin implant.  

In summary, if you are bothered by the contour of your submental area or chin, and are clear on which anatomic area it is that is bothering you—LOL—then you do have good options to help make a lovely improvement. Just contact the A-team at Aesthetica, and we will guide you on the next steps to take. Get started by requesting a consultation using our online form or calling us at (614) 569-2649 

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