Double Chin Botox,

Why You Should Check the Salivary Glands Before Liposuction

Last Wednesday afternoon, a slim woman in her mid-20s

came to the clinic.

“Doctor, I haven’t gained weight, but

the area under my chin keeps getting thicker.

I’ve been going around for liposuction consultations,

and one place said there wasn’t much fat,

while another said we could just suction it out.

Which one is actually right?”

Double Chin Botox,

Not All Botox Is the Same

Double chin Botox is a procedure that reduces

the tissue causing the under-chin fullness

by injecting botulinum toxin into it.

But there is one important thing here.

Unlike the square-jaw Botox most people know,

with double chin treatment, the question of

“where to inject” differs completely from case to case.

Sometimes it is injected into the platysma (the thin muscle at the front of the neck),

sometimes into the submandibular gland,

and sometimes both.

So although it is grouped under the same name,

“double chin Botox,”

it actually refers to procedures targeting completely different tissues.

I had liposuction—why does it look the same?

The key point of this article

I had double chin liposuction—why does it look the same?

About half of double chins in slim people

are actually enlarged submandibular glands.

If it’s a salivary gland, not fat, suctioning has zero effect.

Identify it first with ultrasound,

and 20–40 U of Botox is the right answer.

If you searched for double chin Botox and found this page,

you’re probably in a situation like this:

“I haven’t gained weight, but my under-chin area looks thick,” or

“I got a liposuction consultation, but something still feels off.”

That’s likely the case.

In fact, those two concerns usually come from

almost the same root cause.

Let me walk you through some of the cases I’ve seen in the clinic.

When a slim patient, someone with a BMI under 20,

comes in for double chin concerns, I almost always

start with ultrasound.

That’s because in this body type, nearly half of the reasons the under-chin area looks thick

is not fat, but

an enlarged submandibular gland.

The submandibular gland is a salivary gland that produces saliva,

and surprisingly many people are either genetically large

or chronically enlarged.

Why does this matter?

Because a salivary gland is not fat,

so it cannot be removed by suction.

Even if a cannula goes in, there is nothing to grasp.

So even if you undergo liposuction,

the thickness stays the same.

You end up spending the cost,

taking on the scar risk,

and getting zero results.

Then what should be done if the gland is enlarged?

We inject 20–40 U of Botox

directly into both submandibular glands.

When Botox reduces the gland’s secretory activity,

the gland itself atrophies and becomes smaller.

The effect usually appears after 2–3 weeks

and lasts 4–6 months.

Many people find this surprising, actually.

Last month, a slim 25-year-old woman came in,

and she had already received liposuction quotes

from two other clinics.

When we checked with ultrasound, the fat layer was really thin,

and both submandibular glands were about 1.5 times larger.

So I did not recommend suction.

I told her, “If you have suction now, you’ll 100% regret it,”

and injected 30 U of Botox into each submandibular gland.

Six weeks later, she was shocked when she looked in the mirror.

Dr. Wi Young-jin’s Key Takeaways

• In slim patients, a double chin is

  more likely not to be fat.

• Before deciding on suction, check the fat layer thickness

  with ultrasound first.

• If it’s gland enlargement, suction has zero effect,

  and 20–40 U of Botox is the right answer.

Diet Botox,

The Truth About Calf and Square-Jaw Effects

I’ve made a table for easier viewing.

One thing people who come in for double chin Botox

also ask about a lot is

calf and square-jaw Botox.

People often call it “diet Botox,”

but to be honest,

that phrase itself can be a little misleading.

Botox reduces muscle—it does not

make you lose fat.

If you look at the table, there’s one common point.

In every area, the effect is weaker

for the “fat type.”

The same is true for calves.

Among people who come in for Botox,

there are quite a few whose calves are actually fat-dominant,

and giving Botox to those patients

barely changes the thickness at all.

That’s why, no matter the area,

I identify the tissue first before treatment.

For double chins, I use ultrasound.

For calves, I look at muscle change when standing on tiptoe.

For square jaws, I assess the masseter thickness when clenching the teeth.

Botox done without distinguishing the tissue

is half wasted money.

The 3 questions patients ask

the most

Q1. I’ve been getting Botox often, and it feels like the effect is

wearing off. Is it resistance?

A. This needs to be divided into cases.

True antibody-mediated resistance is rarer than people think,

and in the clinic,

about 70% of cases where patients say “the effect seems weaker”

are due to other causes.

The tissue may adapt after repeated treatments,

or compared with the strong initial change,

the result may feel relatively mild.

If true resistance is suspected,

it can be confirmed with a serum test,

and if that is the case, we try switching

to a different toxin type.

Q2. Double chin Botox—how many sessions do I need?

Do I have to keep getting it for life?

A. For gland-type cases, getting it regularly every 4–6 months

is common,

because the gland itself is very active, and once

the atrophy effect wears off, it grows again.

That said, many patients find the duration

gradually gets longer than it was at first.

Rather than “for life,” the interval is adjusted

according to personal satisfaction.

Q3. If I get submandibular gland Botox, won’t I stop producing saliva

and get a dry mouth?

A. In reality, that’s not the case.

Besides the submandibular glands, there are also the parotid and sublingual glands,

so even if secretion decreases in one gland,

the total amount of saliva doesn’t change much.

With 20 U or less on one side,

most people hardly notice any dry mouth,

and with 30–40 U, some people do report mild dry mouth

for the first 2–3 weeks.

Most people adapt within 1–2 months,

but it’s better to know this beforehand.

If you take away just one thing today —

for a slim-built double chin, check the salivary glands with ultrasound

before deciding on liposuction.

If it’s not fat, the cannula is not the answer.

In the next post, I’ll explain how to decide the timing for retreatment

at the 4-month mark after submandibular gland Botox.

This was Dr. Wi Young-jin.

Read more

• Double chin: start here—fat or laxity?

• Double chin fat-dissolving injections—if you lose weight, won’t it come back?

• Can cheekbone Botox make the corners of the mouth turn downward? [Needles need replacing]

Frequently asked questions

Q. I’ve been getting Botox frequently, and it seems like the effect is becoming weaker. Could it be resistance?

A. True resistance caused by antibody formation is actually rarer than you might think, and 70% of the cases in the clinic where people feel it has "stopped working" are due to other causes.

Q. Double chin Botox: how many sessions do I need? Do I have to keep getting it for life?

A. Rather than "for life," the treatment interval is adjusted based on your own level of satisfaction.

Q. If I get Botox in the submandibular glands, won’t it reduce saliva and make my mouth dry?

A. That’s not actually the case.

Q. If I am on the slimmer side but have a double chin, what should I check before getting liposuction?

A. Before proceeding with liposuction, it is highly recommended to check the thickness of the fat layer using ultrasound. For those with a slimmer build, nearly half of double chin concerns are actually due to an enlarged submandibular gland. Since salivary glands cannot be reduced through liposuction, treating it with 20 to 40 units of Botox may be a much better option.