In short
- “Double chin” is not a diagnosis. Underneath there may be superficial fat, fat lying beneath the muscle, platysmal bands, a prominent submandibular gland or a low hyoid bone. They are corrected differently and not all of them can be corrected.
- 🔑 The height of the hyoid bone sets the maximum angle that can be achieved. It is the position of the bone from which the floor of the mouth hangs, it does not depend on the technique or on the surgeon, and it is why two people having the same operation do not end up with the same neck.
- The vertical bands are the edge of the platysma, a thin sheet-like muscle. They are not skin: that is why they are not corrected by removing skin.
- ⚠️ The neck is the area that relapses most in the whole facelift. In objective follow-up at 5.5 years, the cervicomental angle had improved by 13 degrees with surgery and had given back 69% of what it gained — while the jawline lost only 21%.
- And even so, modern series give low rates of band recurrence: in a review of 12 studies and 2,106 patients, pooled recurrence was 1.4%, with nerve injury at 0.9% and haematoma at 1.8%.
- 🔑 That apparent contradiction is the key to this page: what rarely comes back is the bands and what largely comes back is the angle. They are not the same thing.
- Fuller necks relapse more, and treating the platysmal bands in the midline reduces that recurrence.
- ⚠️ Redefining the cervicomental angle remains, in the words of the most recent systematic review, a controversial and complicated procedure.
The neck is the area people ask about most and the one explained worst. “Double chin” is used for five anatomically different things, and each one needs a different surgical manoeuvre — or none.
This page opens the neck up layer by layer and says what lies underneath each complaint, what can be repositioned and what limit is set by the anatomy you were born with.
The five things that can lie under a double chin
From the outside in:
1. The skin
When the skin has lost elasticity, it hangs. It is what you see in an ageing neck or after significant weight loss. It is treated by removing the excess and redistributing it, and it is the only thing on this list that needs incisions around the ear and back into the hairline in order to be resolved.
2. The subcutaneous fat
The layer of fat that sits above the muscle. It is the most accessible one and the one that responds to liposuction. When someone has a “full” neck with good skin and good muscle tone — typically younger — this layer can be almost the whole problem.
3. The platysma and its bands
The platysma is a very thin sheet-like muscle covering the neck from the collarbone to the jaw. In the midline its two halves can separate over the years, and their free edges then become visible as two vertical cords that stand out when you speak or tense the neck.
🔑 Those cords are muscle, not skin. Stretching the skin disguises them for a while and they come back. That is why the manoeuvre that treats them is platysmaplasty: joining the two halves in the midline and, in many techniques, dividing the lower edge transversely so that it stops pulling downwards.
4. The subplatysmal fat
There is a second layer of fat beneath the muscle. It is the one that produces a neck still full after well-performed liposuction, because the cannula does not reach there: treating it means opening the muscle.
🔑 And it is treated when it needs to be. It is on the list of manoeuvres the operation may include, a little further down. What decides is not the surgeon’s preference but where the volume is: if it is beneath the muscle, that is where you have to go.
⚠️ It is also the layer most often misjudged from the outside. A neck that “did not turn out well” after liposuction is sometimes not a problem of technique: it is that the volume was in a different layer.
5. The submandibular gland and the hyoid
And here are the two real limits.
The submandibular gland is a walnut-sized salivary gland sitting under the jaw. When it is prominent or drops, it produces a rounded bulge just below the jawline that is not fat and does not disappear with anything above. Acting on it is a more substantial surgical decision, with risks of its own.
🔑 At ICPM it is treated when that is what is needed, and only then. It is a more substantial manoeuvre, it is explained as such before surgery and it is not included “just in case”. But when the bulge is produced by the gland, treating it is the only way to correct it: liposuction, platysmaplasty and stretching the skin all fail to.
The hyoid bone is a small horseshoe-shaped bone from which the floor of the mouth hangs. Its height and position set the maximum angle that can be achieved between the chin and the neck. If it sits low and forward, the angle will always be more obtuse, whatever is operated on.
🔑 This is the most important thing on the whole page, and it is almost never said: part of the result a neck can reach is decided before going into theatre. A good surgeon measures it and explains it at the consultation. Anyone promising a particular angle without having examined you has not looked.
What a neck lift does
Depending on which layers are involved, the operation combines several of these manoeuvres:
- Neck liposuction, for the subcutaneous fat.
- Midline platysmaplasty, to join the muscle and treat the bands.
- Resection of subplatysmal fat, when the volume lies beneath the muscle.
- Lateral suspension of the platysma, which redirects the pull backwards and upwards.
- Removal and redistribution of excess skin, where there is any.
🔑 None of those manoeuvres is compulsory and none is done as a matter of course. The technique is assembled for each neck: what that neck needs is included — according to which layers the problem is in — and the rest is left out. Two people with the same double chin can leave theatre having had different operations, and that is not improvisation: it is what makes the result match the cause.
The usual incisions are under the chin — small, in a natural crease — and around the ear back into the hairline if skin has to be treated. When there is only fat and the tone is good, the submental incision is sometimes enough.
🔑 The neck on its own is performed, and so is neck liposuction as a standalone procedure. What decides between the two is the state of the tissues — which layer the volume is in, how the skin is, whether there are bands — and what the patient wants to achieve. A young neck, with good skin, good muscle tone and the volume in the subcutaneous layer, can be resolved with liposuction alone.
⚠️ But a neck on its own and a neck within a cervicofacial lift are not the same operation. If the laxity is also in the cheek and the jawline, treating only the neck leaves an unbalanced result, and that is said at the examination before anything is proposed. The facelift guide explains which area each type treats.
The contradiction in the figures (and what it means for you)
Here are two figures that seem to say opposite things and do not.
Figure one: the neck is what relapses most. A study followed 50 patients for 5.5 years with standardised photography and objective measurements. The jawline had lifted by 6 mm and lost only 21% of what it had gained. The cervicomental angle had closed by 13 degrees and lost 69%. On subjective assessment, the neck was the only area that worsened compared with the immediate postoperative period.
Figure two: the bands rarely come back. A 2025 systematic review pooled 12 studies and 2,106 patients who had neck surgery with division of the platysma. Recurrence of bands was 1.4%. Nerve injury, 0.9%; haematoma, 1.8%; sialoma — a collection of saliva — 0.3%.
🔑 The explanation is that they are two different things. Bands are a muscular problem and, once the platysma has been joined and divided, they tend not to return. The angle of the neck also depends on the skin, the fat, the gland, the hyoid and gravity — and all of that goes on ageing.
What that translates to in clinic: if your main complaint is the vertical bands, the long-term outlook is good. If your complaint is the angle, the improvement will be real and noticeable, and part of it will be given back over the years.
The authors of that review say it without hedging: redefining the cervicomental angle remains a controversial and complicated procedure, and more standardised long-term results are needed to compare techniques.
What makes it last longer
From a paper covering 25 years and 1,089 patients come two conclusions specific to the neck:
- ⚠️ Patients with fuller necks had a higher recurrence rate. The volume you start with matters.
- Opening and treating the platysmal bands in the midline reduced the recurrence of neck deformities, compared with lateral suspension alone.
A review article on management of the platysma is even more direct about the older techniques: those limited to corset-tightening the anterior edge or rigidly suspending the lateral edge appeared to give good results, but recurrence was common and the final result poor. The text describes treating the bands as one of the most frustrating problems in neck surgery.
It is not a pessimistic note: it is the reason why what is done today is done.
What a neck lift is not
- It is not liposuction of the double chin. Liposuction treats only one of the five layers. In a young neck with good skin it can be enough; in a neck with bands or with surplus skin, it is not.
- It is not a device treatment. Radiofrequency and skin-tightening devices have their place in mild laxity, and they do not reposition a separated muscle or remove skin. What they can and cannot do is explained on the FaceTite and Morpheus8 pages.
- It is not a treatment for a double chin caused by weight. If the volume comes from general excess weight, surgery treats the shape, not the cause, and the result moves with the weight.
- It does not correct the hyoid. It is said above, and it bears repeating.
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Frequently asked questions
Why do the cords on my neck still show even though I am slim?
Because they are not fat or skin: they are the free edges of the platysma, a thin muscle that separates in the midline over the years. Losing weight does not remove them — sometimes it makes them more visible — and stretching the skin only disguises them temporarily. The manoeuvre that treats them is joining the muscle in the midline.
Can my double chin be treated without operating on the whole neck?
It depends which layer it is in. If it is subcutaneous fat, with good skin and good muscle tone, neck liposuction can be enough, and here it is performed as a standalone procedure. If there are bands, fat beneath the muscle or surplus skin, it is not. The examination is what decides, along with what you want to achieve.
I had liposuction of my double chin and my neck is still full. Why?
The most frequent cause is that the volume was in the subplatysmal fat — beneath the muscle — where the cannula does not reach, or in a prominent submandibular gland. Neither is treated from the outside, and both are treated here: subplatysmal fat requires opening the muscle, and the gland is a more substantial surgical manoeuvre that is explained beforehand.
How long does the neck result last?
The improvement is real and noticeable, and it is also the area that gives most back over time. In objective follow-up at 5.5 years, the cervicomental angle had recovered 69% of what surgery had gained it, while the jawline lost only 21%. The bands, by contrast, rarely come back: 1.4% in a review of 2,106 patients.
Do the bands come back after surgery?
It is uncommon. In the most recent systematic review, with 12 studies and 2,106 patients operated on with division of the platysma, pooled recurrence was 1.4%.
What are the risks of neck surgery?
In that same review, nerve injury was 0.9%, haematoma 1.8% and sialoma 0.3%. Less frequent were prolonged swelling, dehiscence of the suspension and skin necrosis. The risks of the facelift as a whole are set out in detail on its own page.
Why will my neck never look like someone else’s?
Mainly because of the height of the hyoid bone, which sets the maximum achievable angle, and because of the position and size of the submandibular gland. They are anatomical facts that precede any surgery and they are measured at the examination.
Sources
- Cambiaso-Daniel J, et al. Neck Lift to Treat Platysma Bands and Defining Cervical Angle: A Systematic Review and Pooled Analysis. Facial Plastic Surgery, 2025. PMID 39406360. — Systematic review registered with PROSPERO; 12 papers and 2,106 patients operated on with division of the platysma: pooled band recurrence 1.4%, nerve injury 0.9%, haematoma 1.8%, sialoma 0.3%; prolonged swelling, dehiscence of the submental suspension and skin necrosis as less frequent complications; the authors conclude that redefining the cervicomental angle remains a controversial and complicated procedure.
- Jones BM, Lo SJ. How long does a face lift last? Objective and subjective measurements over a 5-year period. Plastic and Reconstructive Surgery, 2012. PMID 23190814. — 50 primary facelift patients assessed at 5.5 years with standardised photography: jawline elevation of 6 mm with 21% relapse; cervicomental angle closed by 13 degrees with 69% partial relapse; the neck was the only area with subjective worsening at 5.5 years.
- Rohrich RJ, Narasimhan K. Long-Term Results in Face Lifting: Observational Results and Evolution of Technique. Plastic and Reconstructive Surgery, 2016. PMID 27348643. — 25 years and 1,089 patients: fuller necks showed a higher recurrence rate; opening and treating the platysmal bands in the midline reduced recurrence of neck deformities; neck techniques with wide undermining and midline plication help prevent recurrence.
- Marten T, Elyassnia D. Management of the Platysma in Neck Lift. Clinics in Plastic Surgery, 2018. PMID 30268242. — Traditional techniques based on corset-tightening the anterior edge of the platysma or rigidly suspending the lateral edge gave apparently good results, but with common recurrence and a poor final result; treating the bands is described as one of the most persistent problems in neck surgery.
- Cervicofacial Rhytidectomy. StatPearls, NCBI Bookshelf. NBK564338. — Layer-by-layer anatomy of the neck, the role of the platysma and of subplatysmal fat, and the branches of the facial nerve exposed in the cervical approach.
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If it is your neck that bothers you, the first thing you need is not to choose a technique: it is to know which layer your problem is in. At the assessment consultation in Valencia we examine the skin, the fat, the muscle, the gland and the position of the hyoid, and from that comes what can be corrected, how far it can go and what limit your anatomy sets.
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
