A double chin is the angle between chin and neck filled in, and four different things can fill it. A pad of fat under the chin. Skin that has slackened and gathered as its collagen thinned. Tissue that has slid off the jaw and folded forward as the ligaments loosened. Or a chin that sits too far back, so the neck has no angle to meet. Weight, genetics, age and years of looking down all play a part. Fat is often not the main one: in Dr Nish’s experience, most double chins past the mid-40s are at least partly slack skin and a fold. He identifies which at your assessment.

Ask whether it folds or it fills. Pinch gently under your chin and lift your head: a soft pad that fills your fingers and stays there is fat. Skin that gathers in pleats with nothing behind it is laxity. Now look down at a side-on photo: a pocket that drops forward at the jaw edge is tissue that has moved. Many double chins are two of these at once. Dr Nish repeats the same checks at your assessment and shows you the answer side-on before anything is suggested.

Most double chins can be treated without surgery, provided the right finding is treated. Fat is dissolved with a course of fat-dissolving injections. Slack skin is firmed with Sofwave™, which is FDA-cleared to lift lax submental tissue, in one visit with no recovery. A fold is drawn back up with a 720 PDO neck thread lift, with the angle visible before you leave. A chin set back is given reversible filler, only where it changes the result. Two findings mean a staged plan. Significant skin excess is different: there, non-surgical treatment may not achieve what surgery can, and Dr Nish says so and refers you.

Sofwave™ treats the slack-skin part of a double chin, and the under-chin is covered by a specific FDA clearance to lift lax submental tissue. Parallel-beam ultrasound warms the layer where collagen is made, about 1.5 mm down, and the skin firms itself over 12 weeks, building to 6 months. Where the fullness is mainly skin that gathers in the pinch, it is often enough on its own. It does not dissolve fat and it does not reposition a fold, so a pad is dissolved first and a fold is lifted first, with Sofwave™ at a later visit. Its clinical studies reported no loss of fat, which matters where the under-chin is already thin.

What a double chin costs to treat at Medisha Clinic, Mayfair, depends on which finding is treated. A single Sofwave™ session over the face and neck, which includes the under-chin, is £1,800. Neck threads (720 PDO) are £750. The staged Neck Lift Plan, neck threads followed by Sofwave™, is sequenced by Dr Nish and quoted after consultation. Chin filler, where a set-back chin is part of the picture, is £350 per ml. Fat-dissolving injections are priced per session at your assessment; a course of 2–4 is usual. Reviews are included. The £50 assessment with Dr Nish is redeemable in full against treatment, at 58 South Molton Street, Mayfair, London W1K 5SL, near Bond Street station.

They work for the double chin that fills the pinch: a soft pad of fat that stays when your head is up. A course of 2–4 sessions, a month apart, breaks the fat cells down. The pad usually looks smaller from 4–5 weeks after each session, with swelling for a few days in between. They do nothing for skin or a fold. Where the pad sits under slack skin, Sofwave™ follows to firm the skin over the smaller pocket. Dr Nish confirms it is fat before any injection is planned.

Weight loss shrinks the fat part of a double chin and nothing else. It does not firm skin that has slackened or lift tissue that has folded, and after the fat goes the slack often shows more, not less. If your fullness fills the pinch and you are above your usual weight, losing some is a sensible first step. If it gathers or folds, the scales will not change it; that is Sofwave™ or neck threads. Dr Nish tells you which at the assessment, side-on, so you do not spend months dieting at a fold.

Chin filler helps when the chin itself sits too far back. With no forward chin the neck has no angle to meet, so even a small amount of fullness reads as a double chin in profile. A small volume of reversible filler brings the chin forward, restores the angle in one visit, and often reduces how much other treatment is needed. It does not dissolve fat, firm skin or lift a fold. At Medisha it is added to a double chin plan only where Dr Nish judges it will change the result.

Nothing in a Medisha double chin plan needs more than numbing cream or local anaesthetic, and recovery is measured in days at most. Fat-dissolving injections: local anaesthetic, then swelling and tenderness under the chin for a few days. Sofwave™: numbing cream, short pulses of deep warmth, and no recovery at all. Neck threads: local anaesthetic, about 2 days of swelling and tenderness, sometimes a bruise, then a fortnight with no gym, massage, dental work or wide mouth-opening. Most people are back at work the same or the next day. Dr Nish gives you written aftercare and his own contact details before you leave.

Each finding has its own timeline. Dissolved fat does not return unless you gain weight, because the fat cells are gone. Sofwave™ firming shows from 12 weeks, peaks around 6 months and is kept with one session a year. A neck thread lift holds 12 to 18 months; the threads themselves are gone within 6–9 months, and the collagen they leave outlasts them. Chin filler holds 12 to 18 months and is reversible. Reviews at four and 12 weeks are included, and that is when Dr Nish plans the next stage or the maintenance.

You hear it from Dr Nish at the assessment, with a referral to a surgeon. Injections dissolve fat, Sofwave™ firms skin and threads reposition a fold, but none of them removes skin. Where there is significant skin excess under the chin and down the neck, these may fall short of what a neck lift operation can do. Dr Nish tells you that side-on, in the mirror, before anything is booked. You leave with a plan either way, even if the plan is a referral.

Because a double chin needs a diagnosis before it needs a treatment, and every treatment it might need is in one pair of hands here. Dr Nish Shah MD dissolves fat, performs Sofwave™ and places 720 PDO neck threads himself, so your profile decides the plan rather than the equipment. As Senior International Clinical Trainer at Derma Medical, one of the UK’s largest aesthetics training academies, he teaches neck and jawline threads to other doctors. He is Brand Ambassador and Key Opinion Leader for PDO threads and dermal fillers, and the clinic is an official certified Sofwave™ partner. Over 30,000 non-surgical treatments make him one of the most experienced aesthetic doctors in the UK and London. Patients have left 128 five-star reviews on Google, and he tells you plainly if a surgeon is the answer.