From what I understand. A neck lift has better results than liposuction. Which one should I get done on my neck? (Photo)
Doctor Answers 17
This is a long response with points that I would go over during a consultation. Hope it helps :)
If the only fat under the chin was the subcutaneous fat (sub-under; cutaneous-skin) then there would be one less "factor" to consider. Since the fat under the chin is potentially divided into two compartments, subcutaneous fat which is directly under the skin and subplatysmal fat which is fat under the platysma muscle, then understanding that there is actually two compartments can help a surgeon in achieving the results desired by the patient.
Since liposuction under the chin (submental liposuction; sub-under; mental-chin) is performed by many different specialties in addition to facial plastic surgeons and plastic surgeons, such as cosmetic surgeons and dermatologists, some specialties may not have the surgical knowledge and may only offer submental liposuction only, and do not know how to perform a submentoplasty which includes a muscle tightening (platysmaplasty, which is tightening of the platysma muscle under the chin). Some surgeons do offer the platysmaplasty, but for technical reasons (read on), they may think that the the performing the corset platysmaplasty is not worth the extra surgery as compared to submental liposuction alone. If the length of their submentoplasty incision an inch or longer, then I may totally agree with those surgeons who may prefer to only perform the liposuction simply due to the length of the incision.
I think that the risk of lumpiness from liposuction alone is probably very low in experienced hands, but my main concern when performing submental liposuction alone is not being able to deliver enough definition that the patient expects from the subcutaneous liposuction alone. Why? I know there is another compartment under platysma muscle which I would not be able to "go after" with the liposuction alone. If the patient understands this, but does not want to have muscle tightening, then I think it is fine to perform the liposuction alone.
Having started my private practice in 2005, I realize that sometimes when a patient says that they are "fine" with a "less than" result, they have the perogative of changing their minds in the future and asking for "even more" results, or in some cases changing their minds and actually being "unhappy" with the lesser procedure. For these reasons, limitations of procedures as well as going over "all surgical options and alternatives" are important when having the initial consultation. It is not as simple as, "I want liposuction for my double chin." and the surgeon responds, "okay, but there is risk of lumpiness from liposuction." That is only the tip of the iceberg, when discussing submental liposuction. I will go over in detail what I normally go over during a consultation for patients who want submental liposuction, which is actually difficult for only a 1 hour consult, and often times some patients become impatient and don't want to hear any more since they don't think that all of the information is relevant. Sometimes the consults give so much information that they cannot remember all the points I am trying to convey, so this answer to your question will be helpful to future patients of mine.
Here we go:
For patients who are under the age of 45 without significant sun exposure to the neck and decolletage, should be able to contract their skin without needing skin removal behind and/or in front of their ears. Of course there are exceptions to the rule, if a 22 year old that weighed 250 lbs but dropped to 150 lbs, then they may actually have too much skin for their body to naturally contract, and may still need some skin removal. It appears that you do not have a particularly tan appearance and only a couple of ounces of excess fat under the chin, so your skin should contract without skin removal. Skin contraction implies that there is no skin "hanging" but this does not necessarily mean the skin will be tight like a "drum." As long as the skin is not hanging, this would be considered a good result, especially for a younger patient which most surgeons would want to avoid any face and necklift incisions if at all possible.
Although the skin is not hanging, when you pinch the skin or if you lower your chin, some of this contracted skin may fold differently from a person who naturally has a good neck and jawline. For example, if you have a patient who is 5'9" tall and 190-200 lbs with a full neck and double chin, and another patient who is 5'9" and 150-60 lbs with a naturally tight neck and jawline, plastic surgery may make the before and after for the full neck and double chin look very similar to the naturally thinner person, but there may be visible differences differences when the patient who had the submental liposuction or submentoplasty versus the person who has nice neck and jawline naturally, especially in certain neck positions, mainly when their chin is lowered to their chest.
As a facial plastic surgeon and specialist in Face and Necklift surgery, a significant number of patients who come in for face and necklifts consultations have had a prior submental liposuction in the past. They typically report that after 2-7 years they began to develop vertical muscle bands which were not previously present prior to the submental liposuction. For the older patients, the skin has become stretched by the platysmal muscle bands and require a lower face and necklift to help "tailor out" the excess skin under the chin and neck through incisions behind and in front of the ear.
It would be easier for me as a surgeon and for the patient to only perform the submental liposuction. The procedure is typically between 15-30 minutes and the only incisions are about 1/4" under the chin and depending on the patient, two additional 1/4" incisions can be made under the earlobes, if the fat extends deep along the jawline. Because I am seeing patients years later after the submental liposuction performed by other surgeons, my perspective is different in that I worry about how the neck will age over the following 10 years. If you remember the saying, "a stitch in time saves nine." By lengthening the incision an extra 1/4" and spending an extra 30+ minutes in addition to the liposuction time at a younger age may save them a potential submentoplasty in 2-5 years or a necklift and facelift if they are older. For the older patients, the saying may be "3-4 (corset platysmaplasty) stitches in time may save 50-100 (stitches around the ears from a necklift and/or facelift.)" Not as catchy as a stitch in time save nine, but you get the point.
When I perform a submentoplasty (AKA mini-necklift which includes submental liposuction and/or corset platysmaplasty) I extend the incision from 1/4" to 1/2" and I am able to stretch the incision to about 3/4" during the procedure, but the ultimate incision is only about double the size of the submental liposuction. In order to keep the incision as small and as "keyhole" as possible, I use a small, but longer shaped retractor, and a headlight is absolutely necessary. The headlight allows me to move around to look at different parts of the surgical area through this keyhole incision, while leaving the keyhole wide open to perform dissection and suturing of the platysma muscle.
I actually bought a fiberoptic retractor designed for this procedure with even longer and thicker retractor, but I am not able to work with it using the same 1/2" incision. I haven't used it at all since I bought in in 2006. In order to use that retractor, a 1" incision or longer would be needed. The thickness of the retractor is about only 1/2" wide but 1/8" thick, and the fiberoptic light is tube which is just under 1/4" in diameter. The whole retractor fits inside the 1/2" incision, but it covers the entire opening and the only place to see is between the skin and the edge of the fiberoptic light. This does not give enough space to see and work (dissect, sharply excise fat, stop bleeding, and sew muscle together.) If I can only perform the submentoplasty through a 1" long or wider incision, then I would not recommend the submentoplasty either. However, since I am extending the 1/4" incision to 1/2" long, I think the 1/4" longer incision is worth the extra results which the subplatysmal fat reduction and corset platysmaplasty can provide.
Anecdotally, I do have a patient who had submental liposuction performed twice by another surgeon. The first time she had it done, she had a modest improvement in her profile, but not enough to prevent her from asking the same surgeon to repeat the submental liposuction a few years later to further "improve" her profile. The second submental liposuction resulted in vertical platysmal muscle bands and loose skin, which she then spent the following 10 years trying to rid herself of these bands. In retrospect, she tells me that she wishes that she had at least stopped after the first submental liposuction, because although her neck profile was only modestly improved, she did not have vertical muscle bands. She felt the additional reduction in fat under the chin, was not worth the development of vertical muscle bands and loose hanging skin which she felt to be more aging than a worse profile. Additionally, her platysma muscle bands became very "active" when she talked, meaning the platysma muscle bands contract when she talks, but this was not happening prior to the second submental liposuction.
So what happened? I suspect the first liposuction was successful in reducing the subcutaneous fat under the chin, but did not remove any subplatysmal fat. This allowed the platysma muscle to evenly cover subplatysmal fat as a smooth layer, without any loose muscle, since the platysma was a perfect "glove fit" around her pre-existing subplatysmal fat. Since she was not "satisfied" with the profile improvement of the first submental liposuction, she asked to have it repeated. I suspect that with the second submental liposuction, she may have had additional subcutaneous fat removed, but the liposuction cannula may have "dived under" the platysma muscle and liposuctioned the subplatysmal fat layer. The scar tissue in the subcutaneous layer from the first liposuction procedure makes that layer hard to pass the liposuction cannula and relatively the subplatysmal layer was an easier layer to liposuction. Sometimes when there is a lot of scar tissue from a prior liposuction, the round tip liposuction cannula is hard to push through the subcutaneous tissue and this forces the surgeon to have to "push harder" in order to slide the liposuction cannula around under the skin. This harder pushing may have slid under the platysma muscle which never had surgery and thus no scar tissue and ultimately resulted in subplatysmal fat reduction.
This subplatysmal fat reduction is actually a good thing, but since liposuction is a "blind" procedure and no tightening of the platysma muscle is performed in a skilled and "directed" manner, the platysma muscle becomes relatively loose compared to the remaining anatomy of the neck. Since the platysma is loose, the skin can only contract to the loose platysma layer and not any tighter than the platysma layer. Additionally, when the patient lays on their back (supine) the vertical platysma muscle bands disappear, since the loose platysma muscle is able to slide forward when the patient is upright, but back when they lay on their back. If the platysma can slide back and forth when laying supine and standing up, wouldn't you agree that the platysma is "loose"?
The corset platysmaplasty is performed on a patient while laying on their back to essentially lock the platysma muscle as forward as possible to simulate the person sitting up or standing up. When we perform the platysmaplasty the patient is laying on their back, and I suspect that often times the platysma muscle is "under-tightened" because it is naturally smoother and not excessive when the patient is laying supine. When the patient is laying on their back, it is important to tighten the platysma muscle using the corset platysmaplasty as tight as possible to essentially lock forward the platysma muscle so that it does not slide back and forth when the patient is laying back and sitting/standing up.
These observations are from patients who have recurrence or falling necks are the patients that I learned the most from. Since plastic surgery is more art than science, surgeons often learn more from their "difficult cases" than from the procedures that went great and give the results that were expected. I find that the things that I learned from the "difficult cases" also help with the routine cases, and help to prevent pitfalls and also during the consultation, to try to create "realistic" expectations, by explaining why there are limitations with certain surgical procedures, submental liposuction being one of them.
After the corset platysmaplasty is performed, then the subcutaneous layer needs to be fully released to allow the skin to return to its smooth position while they are laying on their back. Essentially the platysma is locked in its forward position while they are laying supine, but the skin happens to be smooth when they are laying on their back. When the sit up, the loose platysma can no longer slide forward along with the skin to create a "turkey wattle" or vertical platysmal muscle bands, and the skin has contracted to hug the newly contoured platysma.
The platysma is the foundation and the skin is the house on top of that foundation. If you were to build a house on a foundation, do you want it to be stable and firm or be able to rock back and forth? To reword the saying, "where the head goes, the body will follow" I will say, "where the platysma goes, the neck skin will follow."
You do not appear overweight so this should not apply to you, but for young patients who are 15-25 lbs more than the weight they want to be at, it would be better for them to lose that weight first, before they have any neck procedure. In the best case scenario, the submental fullness (double chin) may be completely gone, and you just saved yourself thousands of dollars. If the center of the neck is already hanging or vertical muscle bands are beginning to form, and the person is still under 45, then they know that they should have the submentoplasty right off the bat, and may skip the liposuction altogether, since they were able to reduce both their subcutaneous and subplatysmal fat on their own.
As far as long term care for their results, this is what we have in our consent form for necklifts and facelifts: Subsequent alterations in facial appearance may occur as the result of aging, weight loss or gain, sun exposure, pregnancy, menopause, or other circumstances not related to the facelift/necklift surgery, Facelift/necklift surgery does not arrest the aging process or produce permanent tightening of the face and neck. Future surgery or other treatments may be necessary to maintain the results of the operation.
Good luck on your neck profile improvement journey!
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From what I understand. A neck lift has better results than liposuction. Which one should I get done on my neck?
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