Thread Lift or Radiofrequency: Repositioning vs Tightening the Face
Threads reposition, radiofrequency tightens. What the literature reports on both, what Health Canada asks for, and what we don't offer.
A double chin that resists diets, exercises and photos taken from above is frustrating. The first question isn't "which treatment?" but "what's actually under there?". A small pocket of fat and loosening skin look alike in the mirror, and they aren't treated the same way.
This article gives you a simple test to tell them apart, and what answers each one.
Often, it isn't about weight
Many slim people have a double chin. Fat under the chin depends partly on genetics, and it sometimes resists weight loss. With age, the skin of the neck and under the chin also loses firmness, even without weight gain.
Losing weight can help when fat is the cause. It doesn't tighten skin that has loosened.
What's under the chin
Four things shape the profile between the chin and the neck:
- fat, just under the skin;
- skin, more or less firm depending on age and collagen;
- the neck muscle, which can loosen and form bands;
- the bone of the jaw and chin, which sets the starting line.
A chin that doesn't project much can also make the area under it look fuller. That's a separate question, looked at during the assessment.
The profile test, in front of a mirror
Stand in profile, with light from the side, or take a photo.
- Head straight, eyes on the horizon. Look at the line between your chin and neck.
- Head tilted up, chin toward the ceiling. If the fullness almost disappears, it's often loosening skin. If a small pocket stays clearly visible, it's often fat.
- Gently pinch the area under the chin. A soft thickness you can hold between two fingers suggests fat; thin skin that creases suggests laxity.
This test gives you a lead, not a diagnosis. Many people have a bit of both.
| What you notice | What it suggests | What answers it |
|---|---|---|
| A pocket that stays when you tilt your head up | Fat under the chin | A fat-dissolving injection, given by a nurse |
| Fullness that fades with head tilted up, skin that creases | Loosening skin | Radiofrequency heat, which tightens |
| A bit of both | Both causes at once | Both treatments, in the order set at the assessment |
If it's fat: the fat-dissolving injection
A fat-dissolving injection destroys some of the fat cells in the treated area. Here, a physician decides at the mandatory medical consultation whether it suits you, and a nurse gives it.
A 2019 study followed 100 people treated with fat-dissolving injections under the chin (Shridharani, Dermatologic Surgery). More than half had more than one session. The most frequent effects: swelling lasting about a week on average, and numbness lasting about four weeks on average. The author is a consultant for the product's manufacturer, which is worth keeping in mind.
The number of sessions and the amount are decided at the consultation, based on your case.
Heat tightens loosening skin. It doesn't melt fat under the chin.
If it's the skin: heat tightens
XERF radiofrequency heats the deep layers of the skin to contract collagen and restart its production. The skin of the neck and under the chin becomes firmer over a few months. XERF doesn't melt fat: we've read no study showing it, and we won't promise it.
XERF is done in at least two sessions, 4 to 6 weeks apart, then a yearly upkeep. Each 90 min session covers the full face and neck, for $1,500, taxes extra. No downtime: back to your usual activities the same day. Temporary redness is possible. The same reasoning for the neck is laid out in the article on tightening the neck without surgery.
Both at once
When there's some fat and some loosening skin, the two treatments can complement each other. The order and the gap between them are set at the assessment, with the nurse and the esthetician, based on what dominates in your case. We don't give a schedule in an article.
When neither one is the answer
Some cases call for something else:
- excess neck skin hanging in folds: surgery;
- very marked neck bands: to be looked at during the assessment;
- a chin that doesn't project much: another approach, discussed at the consultation.
We tell you at the assessment if a treatment won't give you what you're looking for. The page on double chin describes the concern, and the full XERF details are on the XERF page.
Questions we are asked
Is the result permanent?
Fat cells destroyed by a fat-dissolving injection don't come back. The face keeps aging, though, and weight gain can change the profile. For XERF, results can last 12 to 18 months after a full series, according to the clinic.
Can both be done on the same day?
That's decided with the team at the assessment. We don't set a rule in an article.
Will losing weight fix it?
It can help if it's fat. It doesn't tighten loose skin, and fat under the chin sometimes resists weight loss.
Does it swell afterwards?
After a fat-dissolving injection, swelling is common; it lasted about a week on average in the study cited. After XERF, temporary redness is possible and lasts a few hours.
Does XERF melt fat?
No. It tightens the skin. For a pocket of fat, the fat-dissolving injection is what answers it.
Sources
- Shridharani SM. Real-World Experience With 100 Consecutive Patients Undergoing Neck Contouring With ATX-101 (Deoxycholic Acid): An Updated Report With A 2-Year Analysis. Dermatologic Surgery, 2019;45(10):1285-1293. PubMed Central
- Cleveland Clinic. Radiofrequency (RF) Skin Tightening. my.clevelandclinic.org
- Cynosure Lutronic (manufacturer). XERF. cynosure.com/xerf
