Double Chin: The Cause Becomes Clear When You Feel It — Why 21 Plastic Surgery Classifies It into 4 Types

Hello, I am the director of 21성형외과.

To begin with the conclusion,

the causes of a double chin can be divided into four types: fat, muscle, salivary glands, and sagging skin.

When the cause is different, the surgical plan is also different.

Try pressing under your chin with your hand now.

Whether it feels soft and pliable, whether you can feel a firm lump, or whether there is a bulge that does not decrease no matter how much you press it can indicate a different cause of your double chin.

In this post, the director of 21성형외과 summarizes the four causes of a double chin and the corresponding surgical planning methods based on clinical experience.

The 4 Causes of a Double Chin

You Can Tell by Feeling It

A double chin is not simply a problem of “gaining weight.”

Based on the clinical experience of 21성형외과, the causes of a double chin can broadly be divided into four categories.

Cause	Feel · Characteristics	Solution
① Fat	Soft and pliable; feels easy to pinch	Liposuction (superficial fat + deep fat)
② Platysma sagging	Remains blunt even after fat removal	Muscle tightening (fascial correction)
③ Sagging submandibular glands	Bulging unrelated to fat or muscle	Salivary gland tightening (position correction of the submandibular glands)
④ Sagging skin	Excess skin remaining after fat removal	Skin excision

① When Fat Is the Cause

This is a condition in which excess subcutaneous fat has accumulated beneath the chin.

Even with dieting, the area that remains until the very end is often beneath the chin.

The jawline becomes more defined only when both the superficial fat and the deep fat beneath the platysma are removed.

② When Platysma Muscle Sagging Is the Cause

When the platysma muscle, located at the front of the neck, becomes loose, the area beneath the chin can look blunt and saggy.

Liposuction alone does not correct muscle laxity, so sagging may recur over time.

At 21성형외과, muscle tightening is performed alongside liposuction to firmly secure the loose fascia.

③ When the Submandibular Glands Are the Cause

If the area beneath the chin is bulging even though neither fat nor muscle appears to be the cause, the submandibular glands may be sagging.

If this cause is overlooked, a bulge may remain even after surgery.

At 21성형외과, the position of the submandibular glands is always checked during the consultation stage.

④ When Sagging Skin Is the Cause

This occurs when skin that covered the area remains after the fat and muscle have been corrected.

For those with sufficient skin elasticity, the skin naturally contracts over time.

However, for those with reduced elasticity, the excess skin must also be excised to create a clean line without sagging.

[Surgical Plan]

Double chin liposuction + muscle tightening + salivary gland tightening + skin excision

Actual Case – Woman in Her 30s with 3 Combined Causes

A woman in her 30s visited 21성형외과 because of a double chin that did not improve even with dieting.

The consultation revealed that both superficial and deep fat were substantially accumulated. Her platysma was also considerably loose, and sagging of the submandibular glands was present, making this a case involving three combined causes.

At 21성형외과, liposuction + muscle tightening + salivary gland tightening + skin excision were planned and performed together.

Six months after surgery, the boundary between the chin and neck became clearly defined, and her side-profile silhouette changed significantly.

Frequently Asked Questions (Q&A)

Q. Wouldn’t double chin liposuction alone be enough?

A. If fat is the cause, liposuction alone may be sufficient.

However, when platysma sagging or salivary gland sagging is also present, liposuction alone may leave a bulge after surgery or lead to renewed sagging over time.

At 21성형외과, the exact cause is identified first during the consultation, and only the necessary methods are selected and performed.

Q. Do all four procedures have to be performed?

A. No. The principle at 21성형외과 is to selectively plan only the methods needed according to each patient’s cause.

For someone with fat alone, only liposuction is performed; for someone with accompanying muscle laxity, muscle tightening is added.

Q. Can a double chin recur after surgery?

A. When the cause is accurately identified and comprehensively corrected, the likelihood of recurrence is low.

If only the fat is removed while muscle and salivary gland sagging are left untreated, sagging may return over time. Therefore, analyzing the cause is key to the outcome of double chin surgery.

21성형외과’s Principles for Planning Double Chin Surgery

When planning double chin surgery, 21성형외과 spends the most time identifying the cause.

According to the clinical experience of 21성형외과 as of 2026, more than half of double chin patients have two or more combined causes among fat, muscle, and salivary glands.

• Remove superficial fat and the deep fat beneath the platysma with liposuction

• Firmly correct loose fascia with muscle tightening

• Correct the position of sagging submandibular glands with salivary gland tightening

• Complete the procedure neatly by excising remaining excess skin

When these four elements are connected as one treatment plan, a clearly defined boundary between the chin and neck and a result that is maintained over time can be achieved.

If you are concerned about a double chin, it is important to identify the cause first.

Receive a surgical plan tailored to you through an accurate consultation at 21성형외과.

Thank you.

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