More Than Meets the Chin
Dr Sly Nedic discusses the root causes of the double chin manifestation, as well as the various procedures offered to reduce the bulge.
A double chin occurs when excess fat accumulates under the chin, both above and beneath the thin neck muscle (called the platysma). This can manifest in various shapes and sizes, and is not limited to individuals who are overweight – in fact, slim people are also susceptible to developing a double chin.
The double chin mystery
Why some have it and others don’t
Several factors contribute to a double chin formation, these being:
1. Obesity and weight fluctuations
A double chin is common in individuals with obesity, due to the body storing excess energy as fat in multiple areas, including the face and under the chin. When overall fat increases, the cervicomental angle (the junction between the jawline and neck) becomes less defined, thus making the chin blend into the neck. Now, while weight loss can reduce fat in this area, a double chin may not fully disappear altogether. There are a few reasons for this, namely:
* Skin may have been stretched during weight gain.
* The natural ageing process – it reduces collagen and elasticity productivity, which in turn, prevents the area from regaining firmness.
* Residual fat pockets may still persist.
2. Genetics
Some people develop a double chin due to hereditary anatomy rather than weight gain or ageing. A common genetic factor is a low cervicomental angle. The ideal angle is roughly 105°–120° in women and slightly more obtuse in men. When naturally more open, the smallest amounts of fat can still create the appearance of a double chin. In such cases, the issue is less about body weight, and more about fat distribution and skeletal structure. This genetic predisposition means that even thin individuals can have submental fullness (so weight loss in their case may not resolve the issue).
Furthermore, the chubby chin profile appearance may become more pronounced with age as skin loses elasticity. While medically harmless, a low cervicomental angle with submental fat can create the impression of premature ageing or excess weight (which is why many people seek aesthetic treatments). Options such as improvement of definition and restoring a sharper jawline are often tailored to this patient, alongside other traditional methods for fat deposition removal.
3. Insulin Resistance
A double chin can also signal underlying metabolic dysfunction, particularly when linked to insulin resistance. Impaired insulin use leads to excess insulin, which promotes fat storage under the chin and around the waist. Submental fat may thus be a visible warning of prediabetes, type 2 diabetes, PCOS, or cardiometabolic syndrome (high cholesterol, hypertension, or non-alcoholic fatty liver). Observing other signs of insulin resistance – such as midsection fat, facial hair, skin tags, and darkened neck/armpit skin (acanthosis nigricans) – can confirm the metabolic origin. Addressing aesthetics alone isn’t enough. Without fixing the root cause (like insulin resistance), results won’t last.
4. Additional causes
* Pregnancy may leave persistent submental fat in some women.
* Local fat storage (adiposity) may occur even in individuals with ideal overall weight and cervicomental angles.
* Poor posture contributes to the weakening of neck muscles.
* Constant slouching accentuates the appearance of a double chin.
Effects of a double chin:
• Aesthetic impact: Diminished jawline definition, perceived ageing, or excessive weight. Patients feel less attractive.
• Social and psychological impact: Self-consciousness affecting confidence and relationships.
• Possible health impact: Excess chin fat can exacerbate snoring or contribute to obstructive sleep apnoea (OSA), which is linked to cardiovascular disease and reduced oxygen during rest.
Can exercise help?
Exercises targeting neck, jaw, and chin muscles may improve tone and firmness. However, exercise cannot “spot reduce” fat, which usually requires other treatments.
Treatment options
A thorough examination to identify underlying causes is essential. Aesthetic doctors often treat submental fat first, but a functional medicine approach is necessary when medical conditions such as insulin resistance are involved.
Traditional surgical procedures is another effective option for reducing a double chin (e.g. liposuction), yet it does involve higher risk, cost, and downtime – as well as a requirement for informed patient consent.
Minimally invasive treatments:
• Injectable lipolytic therapy: Fat-dissolving injections that gradually eliminate submental fat.
• Energy-based devices: Non-invasive and minimal downtime. Addresses both fat and skin laxity.
• Jawline fillers: While it improves definition, it must be noted that it does not reduce fat. However, fillers can be combined with other procedures.
In summary
Although a double chin is considered cosmetic, it could also indicate underlying medical conditions. This emphasises the connection between appearance and overall health – as well as the necessity to involve a functional medicine approach to sufficiently treat both underlaying medical condition and double chin adiposity.
Dr Sly Nedic
MD IFMCP
Resources: www.8thsense.co.za
References
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3. DeFronzo RA, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14(3):173-194.
4. Karelis AD. Metabolically healthy but obese individuals. Lancet. 2008;372(9646):1281-1283.
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7. Rohrich RJ, Rios JL, Smith PD, Gutowski KA. Neck rejuvenation revisited. Plast Reconstr Surg. 2006;118(5):1251-1263.
8. Kane MA. Treatment of the lower face and neck with deoxycholic acid. Plast Reconstr Surg. 2017;139(5):1013e–1020e.
A double chin associated with obesity can indicate deeper health issues, thus requiring a functional medical approach
Minimally invasive treatments for double chin
Injectable lipolytic therapy: Fat-dissolving injections that gradually eliminate submental fat
Tags: Double Chin