This is LiMO Plastic Surgery.

When people think of a double chin, most assume it's caused by excess fat.

However, there are actually cases where the double chin appears prominent even without a significant amount of fat.

This is especially common in people with small faces or a recessed chin (retrognathia) — a type known as a "skeletal double chin."

People with a recessed chin generally tend to have a shorter chin that is set back further.

When the chin is short, even slight sagging beneath it can easily appear as a double chin when viewed from the front.

In addition, when the chin is set back, the space between the chin and neck becomes narrower. As a result, even without a large amount of fat, the tissue cannot fit entirely within that narrow space and tends to protrude downward.

In other words, a double chin can occur due to skeletal structure even when there isn't much fat present.

When patients with a skeletal-type double chin are examined by ultrasound, the difference in fat volume compared to people without a double chin is often not significant.

In many cases, the double chin arises not from excess fat, but from a narrow chin-neck space.

To reveal a defined jawline within a narrow space like this, it's important to clear out as much of the submental (under-chin) area as possible.

To do this, it's essential to accurately determine whether the tissue filling the under-chin area is deep fat or muscle.

This can only be confirmed through ultrasound examination.

If the underlying cause is not accurately identified and only the fat is removed, it may be difficult to achieve the expected results.

In such cases, rather than performing liposuction alone, it's important to address the deep fat layer as well, and a process to sufficiently create more space beneath the chin may be necessary.

When the submental tissue adheres well to the space created by fat removal, the boundary between the chin and neck can become noticeably more defined - even without bone-related surgery.

One patient mentioned that having no defined jawline was a source of complex, and that she had undergone INMODE (fat-reducing treatments) multiple times, but the result was not significant.

Although it appeared on the surface that he had a large amount of fat, the actual examination revealed that skeletal structure was, in fact, a substantial contributing factor.

His chin was not particularly small, but his neck was thick, and the space between the chin and neck was very narrow — structurally similar to a recessed chin, even though the chin itself wasn't especially small.

For this reason, repeated lifting procedures alone had limited ability to improve his condition, and an approach that also addressed the submental structure — including tightening the muscle - was necessary.

This next case is similar.

The patient came in believing he had a fat-type double chin, since the area beneath his chin appeared convex.

In reality, however, what appeared to be fat was simply concealing a skeletal structure with a very narrow chin-neck gap.

In cases like this, repeated lifting procedures or contouring injections may produce only limited improvement, because the underlying cause lies not only in fat, but also in structural factors.

To restore a defined chin-neck angle, both superficial and deep fat need to be removed, and any loose muscle must also be tightened.

This case involved a chin that was not short, but was set back, with no forward projection — making it easy to mistake for a recessed chin.

Even in patients with a small chin, if the skin is thin, the boundary of the side jawline can become well-defined once liposuction is performed effectively.

This patient also had relatively thin skin, so liposuction was able to reveal a clearer side jawline, while muscle tightening in the central area helped restore the chin-neck angle.

Another patient had a relatively small chin, along with skin laxity.

She already had a double chin due to her recessed chin, and this had become more pronounced with the added sagging skin.

In cases of significant skin sagging, a face-neck lift may be necessary - however, this is not always the necessary option for every patient.

Depending on the condition of the tissue, improving the submental structure alone can sometimes bring about sufficient change.

In fact, some patients have enough room for improvement even when their double chin is not particularly severe.

Objectively, this patient's double chin was not especially severe, but there was a decent amount of removable fat, and the muscle was somewhat loose.

In such cases, improving the adherence of the submental tissue can result in a noticeably more defined jawline, while still preserving the patient's original facial features.

The key underlying cause of a skeletal-type double chin is a narrow chin-neck space.

In particular, if the area under the chin protrudes noticeably when the head is tilted downward, or if the face is small but the jawline appears blurred,

and if the patient also has a recessed chin, the possibility of a skeletal-type double chin should be considered.

Even when double chins look similar on the surface, the underlying causes can differ significantly.

What matters most is accurately analyzing the fat, muscle, skin, and skeletal structure, and then selecting an approach tailored to the individual's specific condition.

Unlike a fat-type double chin, a skeletal-type double chin can occur even with a very small volume of fat.

This is not simply a matter of excess fat, but rather a structural characteristic involving a narrow space between the chin and neck.

Unless the chin itself is being enlarged through orthognathic (double-jaw) surgery or genioplasty, effective improvement generally requires removing as much fat as possible while also firmly tightening the muscle.

Because outcomes in this area can vary significantly depending on the surgeon's skill and experience, it's recommended to choose a clinic with a broad range of case experience.