About Neck Liposuction Surgery
Video transcript: The first group of patients we are going to talk about are those who have inherited face and neck features that they may want changed. So the first problem that people often come to see us is fatty deposits underneath the neck. So that could be treated with simply neck liposuction.
In this patient, she has some extra fat in a submental area. Her neck angle is actually more obtuse so it is actually 130 or 140 degrees, and we'd like to sharpen that up a bit by removing some of the fat that sits underneath the neck. Now in her case we also advanced her chin a little bit with a chin implant, but we'll talk about that a little bit later.
Let's talk a little bit about the ideal neck. What we'd like to see is a fairly sharp, deep markation between the vertical and horizontal part of the neck. The ideal angle is somewhere between 105 and 120 degrees. In the case of extra fat in the submental area, essentially what it does is it pushes down the horizontal part of the neck, and it makes that angle more obtuse, so it might be 130 or 140 degrees. So it doesn't make the neck look particularly sharp. When we remove that fat, of course it sharpens up the neck and makes the horizontal part of the neck appear a little bit longer. So let's look at this neck, there is a little bit of extra submental fat, and what that's doing is that's making her mental cervico angle a little bit too acute, so we'd like that to be sharpened if possible. There's no real signs of aging otherwise, the jawline is normal, there's no lax skin, there's no jowl formation, so I think this is an example of a situation where removing of the fat is probably all that's necessary.
Liposuction is done through a small incision made in the submental area. Many patients will have a crease there that's naturally forming, we'll make a small incision that's 2-3 millimeters in length and that will allow for access with our liposuction canulla's underneath the skin. So the fat sitting on top of her platysma muscle but underneath the skin, and that's gently liposuctioned a very small liposuction canulla through that one incision. Once the procedure is finished, sometimes that incision needs to be closed with a small stitch, but often it's so small it doesn't even require closing.
So in the example on the left with the patient with fat in the submental area right in the mid line, an incision in the mid line is all that's necessary. If there's also fat in the lateral parts of the neck as well, then it's helpful to put a small incision just at the base of the earlobe to allow access again to that area with small liposuction canullas.
In our last patient, because she needs advancement to her chin as well, I'll have to extend her submental incision so that it's big enough for me to insert a chin implant. So what I do in this situation is make a slightly longer incision, that allows me access to the chin area and I can still do liposuction to the neck with that, but it allows me at the same time to place a chin implant to project the chin forward. These are the steps for neck liposuction: a local anesthesia is used to anesthetize the skin, so a very small 2 millimeter incision is placed underneath the chin and then domestic anesthetic solution is infused into the neck fat and what that does is it provides anesthesia and also vassal constriction so there's almost no blood loss when we do liposuction procedures. Small canullas are then used through the incision, and these are very tiny tubes with perforations at the end of them, and we put a vacuum on that; so when we pass the canullas through the tissues it essentially vacuums the fat out. Once that's done, a pressure garment is worn for usually 1 to 3 weeks depending on the situation.
What to expect for recovery from liposuction or liposuction with chin augmentation? There's a recovery period for about a week. It's very important particularly with the liposuction that a pressure garment be worn. The pressure garment essentially helps to support the skin that no longer is being puffed out by that extra fat that was there. So what we want to do is try to do is have that skin contract upwards by wearing a pressure garment. We ask our patients to wear it as much as they can for a period of about 3 weeks. The incision that we make either longer or shorter depending on whether they require a chin implant heals extremely well and is closed with dissolvable stitches. There's not really much maintenance involved, they dissolve on their own, other than putting a bit of Polysporin onto the incision. Most people will have some swelling and bruising for about a week, from both the liposuction and from the chin augmentation surgery. I think in most cases, the augmentation is probably more initially because of the swelling, that swelling subsides in a period of 2 to 3 weeks and then the final results are fairly evident.
When is liposuction not an ideal procedure? There's three main situations:
1. When there is significant lax skin,
2. The patient has prominent jowls,
3. The skin is particularly thin
In case of excess neck skin, the problem with liposuction is we are removing some of the fat that is bulging the skin forward, so when we remove the fat and don't remove the excess skin, then there's still extra lax skin that is hanging down in the submental area. So, depending on the the person's age, if there's lax skin preoperatively then we don't usually recommend liposuction on it's own.
In the situation where patients have jowl formation, again, it's an indication that the neck's skin is probably sagging already and that there is extra neck skin. And I think when we do liposuction, it may rejuvenate the lower parts of the neck but doesn't rejuvenate the jowl. And I think in those situations there is a bit of an incongruity between the rejuvenated neck and the age related changes that you see from the jowls; so probably not ideal in someone who has prominent jowls as well.
The problem with thin skin is that sometimes it doesn't camouflage what we've done surgically, so there can be some irregularities that can be seen through the skin after liposuction. So patients with very think skin I don't usually recommend it.
So whenever I'm evaluating someone's neck, I'm always thinking about the risk/reward tradeoff. So in this situation, what's nice about liposuction is that they do remove some of that extra fat that contributes to a poor neckline. The risk of the liposuction is that it may remove the extra fat, but leave someone with a little bit of extra skin there that's not dealt with. The other risk is that sometimes you can get some irregularities that form in the area that is liposuctioned. So what we try to do when thinking about the risk/reward tradeoff is try and choose a procedure that is the least invasive, that will have the quickest recovery time, but will also give the patient a pleasing and appreciable result.
In this situation I think liposuction and chin augmentation for this patient was ideal; quick recovery, it really dealt with the problems that she had in particular, and we didn't do additional surgery that she didn't need.
When looking at the spectrum of face and neck surgeries that we perform, liposuction is really on the low end of the invasiveness, or in terms of recovery time. It probably has a limited use in that it's for patients that just have extra fat or have a recessive chin. The recovery time is very quick, it's very low risk procedure, and I think most patients can go back to work or school very quickly, so it's nice in that sense. So now we'll have a look at her results, again, this is a patient who is quite young, she's in her 20's, she had some extra fat underneath the chin and a poorly projecting chin. So what we've done is liposuctioned the fat from her neck and then advanced her chin with a medium sized chin implant. So this is her results after, much nicer mental cervico angle, she now has a much longer horizontal portion to her neck and her chin is lined up nicely with her forehead and that's about appropriate.