When a patient speaks of a “double chin” or “turkey gobbler neck,” they are usually speaking of the area under the chin, in the front of the neck.

Many people say they hate their profile photos. This might be from a small chin or from excess skin, fat, or a combination of any issues in the neck itself. A small chin also will accentuate problems of excess skin and fat in the neck.

Your doctor must analyze why you have a “double chin” before planning any correction. Double chins may be classified into those with a normal proportioned chin and those who have a small chin, meaning the chin is set back from the rest of the face, best seen in profile.

Patients with small chins will need either a chin implant made of silicone, or injections with a long-lasting filler to bring the chin out appropriately. A chin implant is inserted through an incision just beneath the chin performed under local anesthesia or IV sedation.

Scars from this procedure are imperceptible. Chin implants are permanent, and the injections are temporary, but they can last up to two years or more.

If the patient’s profile is symmetrical or after a properly measured chin implant, the neck fat and skin must be evaluated. If fat in the neck is excessive, but the skin is relatively youthful with minimal sun damage or loss of elasticity, the neck can be liposuctioned.

Smoking and excess sun exposure are the big offenders contributing to loose skin in the face, neck and everywhere. Liposuction in these instances is very gratifying, and a caveat is that it can actually make the person look thinner overall.

This can be performed satisfactorily even with mild excess of skin. The liposuction takes 20 to 30 minutes to perform under local anesthesia.

For people with mild to moderate excess and wrinkled skin, a procedure called ThermiTight can be performed. This involves inserting a probe into the neck under local anesthesia.

The probe emits radio frequency energy, which tightens the skin and melts excess fat. The procedure is minimally invasive surgery with very little recovery time required.

If the skin is wrinkled and loose, a facelift might be required, or a direct excision of the skin, which leaves a scar down the front of the neck. Usually these scars are minimally noticeable, but many plastic surgeons prefer to do a facelift when possible and if acceptable to the patient, so that there is no scar on the front of the neck. With either of these procedures, a liposuction of the neck is performed when needed.

All of the mentioned procedures can be performed at the same time as a chin implant. The results from carefully assessing and treating the patient’s problems can be amazing and dramatic.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand associates.com