Liposuction in jaw area - is it safe or risky?

All plastic surgeons are trained in facial anatomy especially high risk areas of where the facial nerve can be injured. One of them is the marginal mandibular nerve as it crosses the mandible almost exactly where jowls form on older individuals.
Below the mandible the nerve is well protected and runs deep to the muscle layer but the nerve becomes superficial as it crosses over the mandible.
If Liposuction is maintained and done below the mandible the chance of nerve injury is almost 0. if Liposuction is done above the mandible especially in the jowls and there’s a very real risk of damaging the nerve branch. nerve injuries are usually referred to as neurapraxia. Neurapraxia is further subdivided into different categories. mild neurapraxia of the marginal mandibular branch will show weakness of the muscles that move the mouth being obvious during facial expression such as while speaking. mild neurapraxia will resolve within a few days to a few weeks one more severe neurapraxia may take 6 to 12 months to resolve.
In the end nerve injury from liposuction will always recover.
To minimize the risk plastic surgeons simply stay below the mandible and that is generally all that’s needed to get excellent jawline definition and reduce the double chin.
It’s simply a matter of if the surgeon goes above the mandible or not.
The plastic surgeons who is reluctant to do it is not your provider of choice since he doesn’t have experience.
Delivering consistent quality liposuction results is more difficult than most people believe and this includes plastic surgeons.
There is a substantial variation or difference in outcomes purely based on who does the procedure.
Consider that liposuction results are permanent and irreversible patients should be very selective and who they choose for any liposuction procedure.
Somebody who says they’re not comfortable doing it should tell you right off the bat that they are not the provider for you since the fact they’re not comfortable doing it it’s basically saying I don’t do the procedure often or have never done it.
What you really want is a provider who can show you a collection of before and after pictures with a few hundred examples of before and after pictures. If you find one who’s got a massive amount of experience then they may have had some experience firsthand with patients who develop neurapraxia of this nerve branch. personally I’ve done over 8000 and liposuction procedures and do chin and neck liposuction on a regular basis.
I’ve had one case of significant neurapraxia that took more than a month to resolve and two cases that resolved within a week. I learned from my experiences and now I am a little more conservative and never go above the mandible.
Since changing my technique I’ve never had a case of marginal mandibular nerve branch neurapraxia.
In my entire career the worst it’s ever happened I was one single patient who had to put up with this inconvenience for a few months.
Considering that the nerve branch universally heals with normal function given enough time the same cannot be said for poor Liposuction results.
My best suggestion is to not focus on the nerve injury but instead focus on the most talented and experienced provider. do that by having in person consultations at which time you should ask each provider to open up their portfolio and show you their entire collection of before and after pictures. Bing showing a handful of sample pictures which most likely represent the best results of their career is totally insufficient to get a clear understanding of what the average results look like or how many of these procedures the surgeon has performed.
An experience provider should have no difficulty showing you a minimum of 50 sets of before and after pictures of commonly done procedures of which this is one.
Highly experienced surgeons will have hundreds or even thousands of before and after pictures of commonly performed procedures.
Bring with you facial pictures of your own face taken the same way plastic surgeons take before and after pictures.(like mug shots) and use those as comparison. Ask providers to show you as many pictures as possible of patients with very similar facial and neck characteristics to your own.
Ask the provider to show you examples of excellent outcomes, average outcomes and less than outcomes.
You should also ask them with the revision rate is and what their revision policy is.
Asked to see examples of patients who needed revisions and what they looked like before and after. All plastic surgeons have a variety of outcomes and it’s fair for patients to ask to see different types of outcomes from the providers history.
I’ve been doing plastic surgery for almost 25 years. During that time I’ve observed that individuals seeking chin and neck Liposuction almost unanimously all suffer from a facial skeleton imbalance with Amanda bowl that is either small or lacking in projection in comparison to the Maxilla. Recognizing the primary problem is based on bone structure not soft tissue can help people except inherent limitation of what can be delivered with Liposuction.
During that time I’ve observed that individuals seeking chin and neck Liposuction almost unanimously all suffer from a facial skeleton imbalance with Amanda bowl that is either small or lacking in projection in comparison to the Maxilla. Recognizing the primary problem is based on bone structure not soft tissue can help people except inherent limitation of what can be delivered with Liposuction. The great majority of patients who seek this procedure having totally normal fat distribution. Fat is not the inherent primary problem but it is an easy tissue to manipulate.
Having an under sized mandible typically presents with lack of jawline definition, a premature double chin, a dental occlusion overbite, profile pictures will show the upper lip as having more forward projection than the lower lip and premature development of jowls.
Experienced and talented plastic surgeons will recognize the impact of each of the tissue layers and be able to differentiate who is a good candidate and who is not and will know in advance exactly what the results will look like. The ability to accurately assess and predict outcomes consistently is probably just as difficult as mastering the technical aspect of the surgical procedure.
Considering the permanence and potential consequence of poorly done work I suggest all patients take the vetting process of plastic surgeons very seriously and put in their due diligence to find the best provider. Avoid virtual consultations whenever possible and during consultations ask providers to open up their portfolio and show you as many pictures as they’re willing to you. Some may or may not be willing to open up their portfolios it will strictly stick to their pre-selected photo albums.
I think you’ll find that the most confident talented and experience providers will have the least issue with showing you the greatest variety and numbers of pictures.
In the hands of someone sufficiently talented and experienced the chance of nerve injury should be a non-issue.
Best,
Mats Hagstrom MD

For an expert surgeon who knows the anatomy of the face, whether or not to do facial liposuction has nothing to do with nerves or safety. Instead it has to do with what will happen in the future. Over time the face loses volume and most facial procedures done to enhance the aging face are done to add volume, not remove it. Although there theoretically could be a reasonable reason for what you request, in doing liposuction as long as anyone, I have never seen anyone that I thought would be a candidate. Ask the surgeon who does them "all the time" what his patients look like in 5, 10 and 15 years. I will bet he/she can't tell you.