I'm a 21 year old healthy male, but the angle of my neck profile is really starting to bother me - I'd much prefer to have a more pronounced angle between neck and chin. Most of my research seems to point to liposuction as the answer, but I don't think mine is a problem of extra fat. Rather, I think it may have to do with extra skin. The second picture is what I'm looking for (I'm just using my finger to tighten the skin on my neck). What options are best for someone like me?
Is a Neck Lift the Right Option for Me? (photo)
Doctor Answers 6
Neck lift Right for Me?
At your age you do not a neck lift. A small chin implant would take care of what you consider to be loose skin.
Mini-necklift or Isolated Submentoplasty is an option.
Very good question, and reasonable concerns. If you say that you don't feel much fat under your chin, I do believe you, since that is also my experience with younger patients who are thin.
Although the other surgeons are recommending a chin implant, I would instead ask you whether you like your profile using your simulation. If you like how your chin appears "lengthened" by making the area under the neck/chin flatter, and do not feel that your chin is weak, then don't do a chin implant. If you like your simulation, but would like a little "extra" then add the chin implant to what is planned for the work under the chin.
A chin implant alone, even a large or extra large chin implant will create 1/8" to 1/2" more flatness by making the chin look longer going away from the face. If a person's neck appears to start at the wrinkle under then chin, I don't think you can insert a chin implant large enough to give the result you are looking for.
If lines are drawn on your photo along the front of the neck and the back of the neck, these two lines not very parallel and appear to be two lines splaying apart, then liposuction under the chin or submentoplasty will help to contour the tissues which is causing the blunting of the chin/neck angle (cervicomental angle).
As far as liposuction goes, its obvious that we want to deliver an aesthetic result that you will be happy with. However if you don't have much excess fat under the chin, liposuction under the chin can potentially remove the little fat that is remaining between your skin and the underlying neck muscle (platysma muscle). In my practice, I frequently have patients in their 40's who had prior liposuction only under their chin. They like the results initially for 1-5 years, but then noticed that the skin became crepey, sagging and frequently the platysma muscle bands began to protrude or hand through the skin. On examination, the skin is healed directly to the platysma muscle and very little fat was left by the prior surgeon.
The fat underlying the skin of the jaw is usually +/- 1/4" in thickness, so my goal is to leave +/- 1/4 of fat on the skin so that there is a uniform thickness of skin and fat from jawline to the under chin area and back to the other jawline. To liposuction under the chin only, and still leave the 1/4" of fat will likely not make much change in the profile. If the surgeon doesn't see much fat come out, and the patient is scheduled only for the liposuction. then the surgeon will continue to liposuction. This will result in an over thinning of the fat under the chin, leading to 1/4" fat on the jawline (that's normal) then <1/8" of fat under the chin, and then back to the 1/4" on the other jawline. In the worst case scenario, the liposuction cannula can sometimes work its way under the platysma muscle and create a hollow or indentation directly under the chin (AKA cobra neck deformity.)
A Submentoplasty is plastic surgery (-plasty) under (Sub-) the chin (mentum or -mento-). It is also called an isolated submentoplasty or mini-necklift, which does not involve any skin removal. If a submentoplasty is performed with skin removal directly under the chin, that is called a direct necklift.
Although there is the word neckllift in "mini-necklift" there is no skin removed, so it is essentially a fancier version of what we are trying to accomplish with the liposuction, but it does involve "manipulating" the thin neck muscle (platysma) and possibly the underlying fat (subplatysmal fat) but not doing as much with the fat that is normally the target of liposuction (subcutaneous fat AKA fat under the skin).
A submentoplasty includes the following procedures, a 1/2"-3/4+" incision in the wrinkle/fold of skin where the double chin wrinkle forms, liposuction of the submental fat (fat under the chin, but over the platysma muscles AKA pre-platysmal fat) if necessary, a platysmaplasty sewing the middle edge of the platysma together with possible notching of the muscle to help it lay smoother, and possible reduction/excision of "subplatysmal fat" which is the fat under the platysma muscle.
If you don't feel much if any fat under the skin, it is possible that there is more "subplatysmal fat" than there is fat between the skin and the platysma muscle. If that is the case, then liposuctioning that fat doesn't make much sense. Instead finding the platysma muscle (opening the hood of the car) and indentifying the subplatysmal fat and reducing it before sewing the platysma muscles back together to create a uniform flat surface under the chin (closing the hood of the car). If liposuction is performed between the platysma muscle edges the indentation can't be closed because the surgeon cannot sew the two edges together through a liposuction hole in the skin, but instead requires an incision large enough to perform the above procedures.
I wanted to emphasize that no skin is removed in this isolated submentoplasty, so it is not a traditional necklift which involves longer incisions around the ears to remove skin. I agree that a regular necklift would not be the right procedure for you. Since younger patients (younger than 45) tend to have this procedure, once the "foundation" is the shape that we want it, the skin will simply shrink wrap to the new shape similar to the way skin conforms after liposuction procedures.
These are my opinions based on my own surgical experiences.
Neck lift at 21 years old
I don't think a neck lift will be the right choice for you.
You have a relatively weak chin and good skin tone. If your teeth and bite are normal, I'd recommend a genioplasty (moving the chin itself forward) and liposuction under your neck. It would give you a stronger chin and more well-defined neckline.
Hope this helps,
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Is a Neck Lift the Right Option for Me?
No 21 year olds don't require neck lifts. From the photo, you have a weak chin and some extra submental fat. A Chin Implant and micro-liposuction would yield the desired aesthetic results IMHO.
Should I get a neck lift?
It's relatively rare that a 21 year old would have enough skin and muscle laxity to justify a neck lift. In many cases, cautious lipocontouring of the neck does a nice job providing enhanced definition of the cervicomental angle, especially in younger patients. You may also want to consider a chin implant in order to get the best result.
Younger patient with neck concern
Your concern is a valid one as liposuction alone will yield a minimal benefit and I gather you desire a more substatial change. I found in my experience that combining neck liposuction with a "wattle neck" procedure that is an internal tightening suspension of the underlying musculature will yield additional benefit. You may also consider mentoplaty as a way to extend the chin forward. This combination has the best opportunity to make a substatial change in your neck contour.