This is LiMO Plastic Surgery Clinic.

There are people whose faces don't have much fat,
yet they still struggle with a double chin.

In these cases, the cause may not simply be fat, but muscle.

Today we'll explain the characteristics of the "muscular double chin,"
caused by muscle, and how to improve it.

Most people assume the cause of a double chin is fat.

So they often first consider diet, fat-dissolving injections, or procedures
like INMODE or SHURINK, or think about liposuction.

However, the structure under the chin is not as simple as it seems.

Even without much fat, a double chin can form if the skin is thick or the
muscle is well developed.

In particular, men often have a thinner subcutaneous fat layer than women,
so it's common for enlarged muscle rather than fat to fill the area under the chin.

When we actually examine patients with a muscular double chin using ultrasound,
there's a characteristic finding.

There is little to no submental fat, and a relatively large muscle
is visible beneath the platysma.

The precise name of this muscle is the digastric muscle.

It is one of the representative causes of submental volume in a muscular double chin.

A large digastric muscle takes up submental volume
in a way similar to having a lot of fat.

No matter how tightly the platysma supporting the area under the chin
is sutured together, it's difficult to overcome that resistance fully.
 

CASE 01. Liposuction + Muscle Suturing Only

This patient underwent liposuction and platysma suturing while preserving
the digastric muscle, removing only the submental fat.

The submental area, which had been bulging, was significantly refined,
and a defined cervicomental angle (the angle distinguishing the chin from the neck)
was formed.

Overall, there was significant improvement, but some chin/neck tissue still hung down
below the chin, so a slight double chin remained.

Since the preoperative condition was quite severe and the patient was satisfied,
but in practice, many patients who reach this level of result
still come in wanting further improvement.

CASE 02. Digastric Muscle Removal Performed Together

This patient's condition was similar to the post-op appearance shown in the previous case.

People who don't have much facial fat often also have little fat under the chin.

So when touched, rather than the soft, cushiony feel of someone with a lot of fat,
firm muscle can be felt easily.

Since the ultrasound findings closely matched the clinical examination,
digastric muscle reduction was performed along with platysma muscle binding.

After surgery, no chin tissue remained hanging below the chin tip,
and the submental angle formed more naturally and clearly than in the previous case.


 

Even though muscle reduction was performed, bruising was not severe at the one-week mark, and the results remained stable after three months.
 

CASE 03. Thick Neck with Limited Submental Space

The next patient didn't have a small chin, but had a thick neck,
resulting in limited space under the chin.

Although not a recessed chin (weak chin) case, in terms of double chin formation,
 this can be considered a similar condition to having a recessed chin.

Since the muscle was also developed here, partial removal
of the digastric muscle was performed along with platysma muscle binding
 to create a more defined cervicomental angle.

Because the space was limited, submental volume needed to be reduced more,
similar to a recessed-chin patient as removing fat alone was not sufficient.

By reducing the digastric muscle to secure enough submental space,
the axis of the chin tissue naturally shifted, allowing a boundary
to form between the chin and neck.
 

CASE 04. Recessed Chin Combined with Developed Muscle

The next patient actually had a recessed chin.

The chin was set back with weak forward projection, making it a skeletal structure
naturally prone to developing a double chin.

With a recessed chin, the space between chin and neck is inherently narrow,
and with developed submental muscle on top of that, the chin and neck
appeared to merge into one.

Since the chin tissue dropped immediately from the tip of the chin,
sufficient reduction of submental volume was needed to create a boundary
between chin and neck.

However, despite being male, this patient had relatively thin skin and not much submental fat.

So fat removal alone was insufficient, and partial digastric muscle removal
was performed together.

With sufficient volume reduction, the previously hidden boundary
of the front chin was revealed, and the chin and neck, which had appeared merged, became naturally distinguished.

 

CASE 05. Female Patient with Almost No Fat

The next patient was female, with thin skin and almost no fat.

For people like this, pressing gently under the chin immediately reveals firm muscle.

A double chin with a lot of fat feels cushiony and soft when pressed, and you need to
press fairly deep before feeling the resistance of the muscle.

In contrast, when there is little fat, the muscle can be felt almost immediately.
 

To enhance the effectiveness of double-chin muscle binding, it's important
not just to suture the muscle, but also to reduce
the submental volume itself.

However, in a muscular double chin, the digastric muscle is essentially
the only volume that can be reduced.
 

That said, since the digastric muscle is also functional, partial removal is
safer than complete removal.

So for a muscular double chin with little fat, there tends to be a certain limit
to how much volume can actually be reduced.
 

CASE 06. Plenty of Fat but a Shallow Submental Angle

The next patient had a lot of fat, but the submental angle
sloped gradually rather than sharply.

In such cases, simply reducing fat is not enough;
partial digastric muscle removal can also be considered to change
the axis of the submental structure itself.

As a result, not only did the double chin improve, but the submental angle
also formed close to a right angle.

Generally, the ideal cervicomental angle is considered to be around 105 to 120 degrees, and after surgery it was confirmed to stably fall within that range.
 

CASE 07. Sagging Muscle as the Cause

With this last patient, from the side view, it looks like he has a lot of submental tissue
due to sagging under the chin.

However, viewed from a three-quarter angle, the jawline boundary
was relatively clearly visible.

A double chin where the jawbone boundary is visible like this often has little fat, with the main cause of being sagging is submental muscle.

Of course, this appearance doesn't occur simply because the muscle sagged.

It was possible precisely because, with little fat, the muscle
had been filling the submental space.
 

So this patient underwent both muscle binding and partial digastric muscle removal,
which allowed the previously sagging submental tissue
to naturally tighten toward the jawline.
 

A muscular double chin is a type of double chin where submental muscles like the digastric muscle have a greater influence than fat.

Therefore, double-chin liposuction alone may have limitations, and depending on the condition, double-chin muscle binding or partial digastric muscle removal
may also be considered together.

However, since the digastric muscle is generally located much deeper
 than the submental fat that is typically removed, caution is required during surgery.

Also, since results can vary depending on the surgeon's experience and skill level, it's advisable to thoroughly consult with a medical team that has experience
with a variety of cases.

LiMO Plastic Surgery Clinic does not approach the double chin simply as a matter of fat. Instead, after checking the condition of the fat layer and muscle layer through
ultrasound examination, we establish a surgical plan tailored
to each individual's specific cause.

Based on extensive experience with double-chin and facelift surgeries,
we aim to create a natural, smooth boundary
between the chin and neck, by considering combined causes
such as fat, muscle, and skin sagging together.