Double chin: is it due to fat or loss of elasticity?

💡 Check this before reading


Q. Isn't Ulthera the right answer for a double chin?

A. The approach changes completely depending on whether the cause is fat or loss of elasticity. If you get treated without identifying the difference, the effect may be minimal, or you may just waste time and money.


Q. How can you tell what causes a double chin?

A. There is a simple way to check at home, and in the clinic it can be identified relatively clearly through palpation and visual examination.

💡 Key insight from Dr. Wi Youngjin

To get rid of a double chin, don't just do Ulthera. First, figure out whether it's fat or loss of elasticity.

The saying that Ulthera alone is enough is only half true

If you search because of a double chin,

words like "Ulthera," "liposuction," and "carboxy"

start popping up everywhere.

But there's one important thing here.

There are broadly two reasons a double chin appears,

and if you get a procedure without distinguishing between the two,

there are quite a few cases where you don't see proper results.

The first is fat overaccumulation.

This is when a lot of fat cells are actually stored under the chin.

In this case, if you lightly pinch under the chin with your hand,

you'll feel a thick, bulky lump.

The second is loss of elasticity.

This is when the skin and subcutaneous tissue sag downward

because of gravity, making it look like a double chin.

In this case, it's not that there is too much fat,

but that the supporting force has decreased.

To be honest,

many people have a mix of both.

But depending on which one is the main cause,

the procedure you should choose changes.

If fat is the problem and you get Ulthera, which is a skin-tightening treatment,

it may tighten the skin a little, but the bulge will remain.

On the other hand, if elasticity is the problem and you only remove fat,

the skin may end up looking even saggy.

👨‍⚕️ Dr. Wi Youngjin's key takeaway:


If you want to get rid of a double chin,


don't book Ulthera first.


The first step is to determine whether it's fat or loss of elasticity.


If you choose a treatment without knowing the cause,


most of the time the problem is not the device itself, but the wrong direction.

Find out which type your double chin is like this

There's a simple way to check at home.

① Pinch test

When you lightly pinch under your chin with your thumb and index finger,

if it feels thick and bulky when pinched → likely fat overaccumulation

if there's not much to grab but it looks saggy → likely loss of elasticity

② Check while tilting your head back

If the double chin largely disappears when you tilt your head back,

loss of elasticity is likely the main cause.

If it still looks bulging even when you raise your head,

fat may be the main cause.

What makes this tricky is

that many people have both at the same time.

After the mid-30s,

mixed cases with both fat and reduced elasticity are common.

In that case, determining which factor has the larger share

becomes the key to planning treatment.

The treatment approach changes like this depending on the cause

It varies from case to case,

but this is generally how I approach it.

When fat is the main cause

I first consider fat-dissolving injections (carboxy, Saxenda-type treatments, etc.) or

submental liposuction.

If the amount isn't large, injections may be enough to tidy it up,

and if the amount is substantial, liposuction is much more certain.

When elasticity is the main cause

I prioritize treatments like Ulthera or Thermage

that stimulate the deep layers of the skin and tighten them.

HIFU (high-intensity focused ultrasound) is the 대표적인 category,

and simply put, it uses heat to contract

the fascial layer inside sagging skin.

When it's a mixed case

This is something many people misunderstand,

but if you do a tightening procedure first in this situation,

the bulging fat may actually become more noticeable.

So I approach it by reducing the fat first,

and then improving elasticity afterward.

But it's not always simple.

After reducing fat, if extra skin remains,

there can be a period when it looks even more saggy.

For about 2 to 3 weeks, the shape may actually look awkward,

so I explain that in advance before proceeding.

There were quite a few cases where people had Ulthera several times elsewhere

and saw no effect at all,

but after coming to us, we identified the cause and changed direction toward fat reduction,

and they were satisfied after just 2 to 3 sessions.

It wasn't that the treatment was wrong; the direction was wrong.

Frequently asked questions

Q1. I haven't gained weight, but I developed a double chin. Why is that?

A. A double chin that appears without a change in body weight

is usually due to loss of elasticity.

As we age, the collagen and elastin that support

the skin and subcutaneous tissue decrease,

and the fascia (the SMAS layer, the muscle membrane beneath the skin) also loosens.

On top of that, a posture that pulls the chin downward—such as

constantly looking at your smartphone—repeatedly pulls the skin in the direction of gravity,

making it sag faster.

A double chin that appears even without weight gain

often responds better to elasticity-focused treatments than fat treatments.

Q2. Are double chin procedures permanent?

A. Honestly, there is no permanent procedure.

Liposuction physically removes fat cells, so

its maintenance period is the longest,

but elasticity treatments involve the skin aging again,

so maintenance is usually needed every 1 to 2 years.

Rather than expecting it to be solved in one treatment,

it is more realistic to think in terms of ongoing management at appropriate intervals.

Q3. If I have both cheek fat and a double chin, which should I treat first?

A. If you have both cheek fat and a double chin,

we usually first establish an overall lower-face contour plan.

If you only treat one area, the other side may look relatively more prominent,

so it's important to look at the overall proportions and decide the priority.

The right approach is to assess the entire face during consultation.

This has been Wi Youngjin.

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