Hello, I am Dongju Hyun, M.D., the Medical Director and a Board-Certified Dermatologist at TERRA Dermatology Clinic.
The latest trend in non-invasive lifting treatments has evolved past simply “pulling” the skin. Today, it is about “contouring”—simultaneously reducing undesirable fat pockets while restoring deep dermal elasticity. Among these modern solutions, ONDA Lifting, which utilizes 2.45GHz microwaves, has become highly sought after for its unique ability to destroy fat cells and regenerate collagen with minimal to no patient discomfort.
During consultations, many patients ask, “How many Joules do I need?” or “Will applying maximum energy yield better results?”
To give you a straightforward answer: No, higher energy does not automatically translate to superior results.
Every individual possesses a completely unique bone structure, fat thickness, and degree of skin sagging. Because the anatomical structures of submental fat (double chin) and jowls (sagging lower cheeks) are entirely different, optimal clinical outcomes are only achieved when the total energy is calculated precisely according to fat volume and severity grade.
Today, we will scientifically analyze your double chin grade based on clinical peer-reviewed data and determine the exact target energy your skin requires.
1. What is My ‘Double Chin Grade’?
Before starting any procedure, we must objectively evaluate the condition of your submental fat. A recent study targeting the Korean population classified submental fat into five distinct stages (Grades 0 to 4) using the Submental Fat Rating Scale (SMFRS) based on visual presentation and the cervicomental (chin-to-neck) angle.
Review the grading scale below to identify where your profile stands.
[Table 1] Korean Submental Fat Rating Scale (SMFRS) & Characteristics
| Grade | Fat Volume | Cervicomental Angle | Double Chin Status | Jawline Visibility |
| Grade 0 | None | 113.3° (±5.1) | Absent | Clearly Defined |
| Grade 1 | Mild | 117.8° (±11.5) | Absent | Visible |
| Grade 2 | Moderate | 132.0° (±12.1) | Superficially Observable | Faintly Visible |
| Grade 3 | Severe | 132.5° (±7.9) | Thick Profile | Not Visible |
| Grade 4 | Very Severe | 139.8° (±13.2) | Completely Obscured | Buried in Tissue |
Note: Reading text descriptions can sometimes feel abstract. We recommend comparing your direct profile in a mirror with clinical reference photos during your in-office evaluation.
2. Determining Your Total Required Energy (Joule)
To achieve visible contouring results with ONDA, the temperature of the subcutaneous fat layer must be elevated to 50°C–55°C to induce fat cell apoptosis (destruction) and lipolysis (melting).
On average, submental fat has a volume of about 24cc. If we were to isolate and heat this amount of fat outside the body, elevating its temperature by 15°C would require less than 2,000 Joules.
However, the human face is highly susceptible to rapid heat loss.
The face, and the submental area in particular, is densely populated with blood vessels. Much like keeping the windows open while turning up the heating, this rich blood flow constantly carries heat away—a phenomenon known as the thermal wash-out effect. If a sufficient amount of energy is not consistently delivered, the fat layer will never reach the critical threshold required for permanent cell destruction.
To effectively induce apoptosis and tissue remodeling rather than just a mild warming sensation, a minimum cumulative energy of 60,000 Joules is clinically necessary for moderate cases.
A. Customized Submental Fat (Double Chin) Protocol
Higher SMFRS grades correspond to increased volume and thickness, which directly demands a higher accumulation of total energy.
[Table 2] Recommended ONDA Energy by Submental Fat Grade
| Grade (SMFRS) | Fat Thickness & Profile | Recommended Energy | Clinical Strategy |
| Grade 0 ~ 1 (Prevention) | < 5mm Minimal fat present | 40,000 J | [Tightening] Rather than destroying fat, the goal is to trigger collagen regeneration within the upper dermis to enhance baseline skin elasticity. |
| Grade 2 ~ 3 (Recommended) | 5mm ~ 10mm Blunted, dropping jawline | 60,000 J | [Contouring] The optimal window for maximum efficacy. We target 60,000J to overcome the thermal wash-out effect and maintain target fat temperatures. |
| Grade 4 (Highly Critical) | > 15mm Jawline buried in fat | 70,000 J+ (Combination) | [Volume Reduction] Requires advanced protocols exceeding 70,000J, ideally combined with complementary treatments like Ultherapy Prime or lipolytic injections. |
B. Customized Jowl Fat / Marionette Line Protocol
Jowl fat behaves differently than submental fat. While a double chin is typically a straightforward accumulation of fat, jowls are the result of age-related fat pad migration (sagging downward) and localized hypertrophy (enlargement of specific compartments). The fat volume here is relatively small—about 2 to 4cc per side (totaling 4 to 8cc), which is only one-third of typical submental fat.
Therefore, instead of aggressively applying raw energy, it requires a sophisticated approach: reducing the weight of the fat pocket while tightly snapping the loose skin back into place.
[Table 3] Recommended Energy for Jowls & Lower Face Contouring
| Treatment Area | Target Fat Volume | Recommended Energy | Core Clinical Focus |
| Jowls (심부볼) | Approx. 4cc ~ 8cc | 20,000 J ~ 30,000 J | While the fat volume is low, a high-density energy delivery is required for dermal tightening. Because major nerves traverse this zone, the handpiece must be kept in constant motion to disperse energy safely. |
| Lower Face Total (Submental + Jowls) | Approx. 28cc ~ 36cc | 60,000 J ~ 100,000 J | Treating the submental area and both jowls in a single session creates a seamless, continuous anchoring effect, maximizing lower face jawline definition. |
3. Clinical Considerations: The Art of Personalized Design
These data points represent standard clinical guidelines. In practice, we must adapt these numbers based on each patient’s real-time skin parameters:
- Objective Fat Volume Measurement: We utilize high-resolution diagnostic ultrasound to directly measure skin and fat thickness or estimate fat volume via BMI to adjust energy inputs against the visible grade.
- Skin Laxity Evaluation: In cases where sagging is caused by loose skin rather than excess fat, high-wattage fat-melting modes are counterproductive. Instead, we deploy a Low-Watt, Long-Duration technique using a 3mm handpiece to slowly deliver energy, safely restoring dermal elasticity.
- Safety First: For patients with low fat volume, improper settings can risk facial nerve irritation or unwanted cheek hollowing. We map out a precise anatomical blueprint before the handpiece touches the skin to mitigate these side effects.
Conclusion: What is Your Tailored Lifting Energy?
In summary, the ultimate success of an ONDA lifting treatment relies entirely on customized energy architecture.
- For Grade 2–3 submental and jowl fat, a substantial delivery of 80,000 Joules is necessary to trigger measurable fat reduction.
- For Grade 4, a highly precise, advanced protocol of 100,000 Joules is required.
Rather than simply shopping around for the lowest ONDA lifting “price,” it is paramount to choose a clinic capable of accurately diagnosing your Submental Fat Rating Scale (SMFRS) grade and engineering an exact cumulative Joule target.
At TERRA Dermatology Clinic, we combine peer-reviewed science with extensive clinical data to propose the most precise energy design and contouring layout for your unique facial profile. If you are curious about your double chin grade or require a comprehensive scientific evaluation, we welcome you to visit our clinic.
Thank you. This has been Dongju Hyun, M.D.