Dr. Esin Özlem Atmış
Double Chin Surgery and Laser Lipolysis
Treatment for fullness under the chin, starting with the question that decides everything: is it fat, skin, muscle or the shape of the jaw?
Facial surgery · Under the chin and jawline
Fat, skin or muscle: the cause decides the treatment.
Fullness under the chin can come from fat above the neck muscle (platysma), fat beneath it, loose skin, muscle bands or the shape of the jaw. Liposuction and laser-assisted lipolysis treat fat above the platysma; fat beneath the muscle needs more surgical methods.1
Loose skin and muscle bands are treated with a neck lift, which can only be done surgically.2 This page explains how the right treatment is chosen, how laser lipolysis works, preparation, recovery, risks and travel planning.
In short
- Liposuction and laser lipolysis work for fat above the neck muscle; they do not treat fat beneath it.1
- Laser lipolysis uses a fibre through a 1 mm cannula to heat and break down fat; it can tighten the skin a little and seal small vessels.1
- Incisions are tiny, a few millimetres under the chin.1
- Loose skin or visible neck bands usually need a neck lift instead.2
- Swelling, bruising and discomfort are common for a short period.1
What causes a double chin, and what treats it
| Main cause | Usual treatment |
|---|---|
| Fat above the neck muscle, good skin | Liposuction or laser-assisted lipolysis1 |
| Fat beneath the neck muscle | Surgical access under the chin, often as part of a neck lift1 |
| Loose skin, vertical muscle bands | Neck lift, which can only be done surgically2 |
| Jowls breaking the jawline | Facelift, often with a neck lift3 |
| A small or set-back chin | Assessed separately; fat removal alone will not change the profile |
Many people have a combination. Removing fat from under the chin when the skin is loose can leave the neck looking emptier but not tighter, which is why the skin and muscle are examined as carefully as the fat.
How laser lipolysis works
In laser-assisted lipolysis a laser fibre is passed through a 1 mm cannula under the skin. The laser heats and breaks down fat cells, causes some skin retraction and seals small blood vessels, which may reduce bleeding during the procedure. The loosened fat is then removed through small incisions under the chin.1
Traditional liposuction is still considered the most effective way to remove larger amounts of fat; laser lipolysis is an adjunct, not a replacement for a neck lift.1 Injections that dissolve fat under the chin are a non-surgical option for small amounts of fat.2
The consultation
01 · Listen
What bothers you in profile and in photos, and whether your weight is stable.
02 · Examine
Pinch test of fat, skin quality, neck bands, jawline, chin projection and the position of the voice box.
03 · Check health
Medicines, bleeding history and anaesthesia risk.
04 · Decide together
Fat removal alone, a neck lift, a combination, or no surgery.
Before surgery: blood thinners, supplements and smoking
Bring a written list of every medicine, injection and supplement you take, including doses. The table shows what usually happens; it is not an instruction to stop anything yourself. Blood thinners protect against stroke and clots, so any pause is agreed with the doctor who prescribed them.4
| Medicine | What usually happens before planned surgery |
|---|---|
| Warfarin | Usually stopped about five days before surgery; some patients need a temporary heparin injection plan.4 |
| Apixaban, rivaroxaban, edoxaban, dabigatran | Usually paused one to two days before, depending on bleeding risk; dabigatran needs longer when kidney function is reduced.4 |
| Clopidogrel, ticagrelor, prasugrel | If the cardiologist agrees, usually stopped about 5, 3 to 5, and 7 to 10 days before respectively. After a recent coronary stent, planned surgery is often postponed.4 |
| Aspirin | Often continued when it is taken to protect the heart; the decision is individual and made with your prescribing doctor.4 |
| Ibuprofen, naproxen and similar painkillers | Increase bleeding and are usually avoided before surgery; paracetamol is the usual alternative.5 |
| Vitamin E, ginkgo, garlic, ginseng and other supplements | Can increase bleeding; usually stopped at least two weeks before, sometimes three.6,3 |
| Weight-loss or diabetes injections (GLP-1 medicines such as semaglutide or tirzepatide) | Most people can continue them, but the anaesthesia team must know. Surgery may be postponed during dose increases or if you have nausea or vomiting; some patients need a liquid diet for 24 hours before.7 |
Bleeding disorders. Tell us at the first contact if you have a diagnosed bleeding disorder (for example von Willebrand disease or haemophilia), a low platelet count, liver disease, or a history of unusual bleeding after tooth extractions, operations or with periods. Blood tests and a haematology opinion come before any surgical plan. Some people are better served by not having elective cosmetic surgery at all.
Blood pressure and diabetes. Poorly controlled blood pressure or diabetes increases the risk of a collection of blood under the skin (haematoma) and of poor healing; both should be well controlled before surgery.3
Smoking and nicotine. Stop all nicotine, including vapes, patches, gum and snus, at least three to six weeks before surgery and for three to six weeks afterwards. Nicotine narrows small blood vessels and raises the risk of wound problems and skin loss; if you relapse, tell us, because postponing is safer.8
The procedure
Liposuction or laser lipolysis of the chin is usually done under local anaesthesia, sometimes with sedation, through stab incisions of a few millimetres under the chin.1 When it is combined with a neck lift or facelift, general anaesthesia is used. A supportive chin strap is commonly worn for a period afterwards.
Recovery and risks
Swelling, bruising and discomfort are common after treatment; patients treated with laser lipolysis may have less pain and bleeding than with liposuction alone.1 Most swelling settles over the following weeks, and the final contour is judged after a few months.
Risks include lumpiness, skin burns from the laser, infection, contour irregularities, asymmetry and nerve injury. In a retrospective study of 537 patients treated with laser lipolysis, complications occurred in under 1% (burns and one infection). A temporary weakness of the lower lip, caused by irritation of a small facial nerve branch, has been reported and resolved within two months.1
Travelling to Istanbul for double chin treatment
Many patients travel from other cities or countries. A clear plan makes the trip calmer and safer:
- Online consultation first: most international patients start with an online consultation. Send your concern, your medical history, your medicines and a few clear photos through the channel the practice arranges, before you book flights.
- Arrive at least one day before surgery: the anaesthesia assessment and the final examination take place before the day of the operation.
- Hospital stay: fat removal alone is usually a same-day procedure; when combined with a neck lift or facelift, one night is planned and a second night is optional.
- Time in Istanbul: for fat removal alone the stay is short, usually a few days until the first check; the exact number of days is confirmed after the consultation. When combined with a neck lift or facelift, plan about seven days.
- Follow-up: reviews are planned at 1 month, 3 months, 6 months and 1 year. They can be done online if you live abroad; you will know whom to contact for urgent questions after you return home.
Dr. Atmış and the neck
Op. Dr. Esin Özlem Atmış is an ENT and facial surgeon in Istanbul. She completed her specialist training in otorhinolaryngology at Ankara University Faculty of Medicine in 2014 and is a member of the Turkish Facial Plastic Surgery Association. She is one of the congress presidents of Face Bosphorus 3 (Istanbul, April 2026), a meeting on facial anatomy and medical practice. At Face Bosphorus 2025 she gave an opening talk and chaired sessions on the upper face and periorbital region, biostimulators and whole-face assessment; she was a listed speaker at Face Minima 2025, and at the 4th Congress of European ORL-HNS in Barcelona (2017) she chaired sessions that included facial anatomy. Details are on her scientific activities page.
As an ENT surgeon she works daily with the anatomy of the neck, including the muscles and nerves around the jaw. She treats the chin and neck as part of the lower face, so that fat removal does not leave a contour that no longer matches the jawline.
Her approach starts with understanding the concern before discussing an operation: what has changed, how it affects you, and which structures are actually responsible. The aim is a proportionate plan that keeps your expression and character, which sometimes means a smaller procedure, a different order of treatment, or no surgery. Besides Turkish, she speaks English and Italian.
Frequently asked questions
Will the fat come back?
Fat cells that are removed do not return, but the remaining fat can still grow if you gain weight. A stable weight before treatment helps.
Will my skin sag after fat removal?
If skin quality is good, it usually adapts. If the skin is already loose, a neck lift is more appropriate than fat removal alone.2
Is laser lipolysis better than liposuction?
It adds some skin retraction and may cause less pain and bleeding, but liposuction remains the most effective method for larger amounts of fat.1
Can injections remove a double chin?
Fat-dissolving injections are an option for small amounts of fat under the chin; they do not tighten loose skin or bands.2
When will I see the result?
Some change is visible early, but swelling hides the final contour for several weeks to a few months.
Is it painful?
Most people describe soreness and tightness for a few days, managed with regular pain relief.1
Clinical references
- Dong J, Amir Y, Goldenberg G. Advances in minimally invasive and noninvasive treatments for submental fat. Cutis. 2017;99(1):20-23.
- American Society of Plastic Surgeons. Neck lift.
- Mayo Clinic. Face-lift.
- Perioperative management of antithrombotic medications: guidelines from the American College of Chest Physicians (summary in Am Fam Physician, 2023).
- Mayo Clinic. Blepharoplasty.
- American Society of Anesthesiologists. Herbal and dietary supplements and anesthesia (patient leaflet).
- American Society of Anesthesiologists. Multi-society guidance on GLP-1 receptor agonists before elective surgery (2024).
- American Society of Plastic Surgeons. How nicotine sabotages plastic surgery.
This page is general information, not a personal diagnosis or treatment recommendation. Medicines must never be stopped without the advice of the doctor who prescribed them. Seek urgent medical care for heavy bleeding, rapidly increasing swelling, breathing difficulty, chest pain or sudden vision changes after surgery.
Start with a careful, honest consultation.
A consultation is not a commitment to surgery. It is where your concern, your anatomy and your health are looked at together.