Deep Plane neck or lipo? (Photo)

Question

Please help. I had two treatments of cool sculpting over the summer of 2023 under my chin. My chin has gotten bigger, or sagging? It was never hard fat always soft. Started a with allergen, they are only wanting to pay for visor lipo? I am under the understanding that after seeing four surgeons, they all tell me I need a submental platysmoplasty, and the last surgeon is telling me that he recommend deep plane w fat grafting?

Shitel Patel, MD · Answer

Looks like you have some extra tissue under the chin (from photo). This can be addressed in a couple of ways:
1. Liposuction +/- muscle repair (pull in the middle)2. Necklift + liposuction (pull behind ears)
An exam would be required to see what the best option would be. For the fat grafting portion, I dont see any contour irregularities from a single view photo(needs to be examined). Self exam for you would be: to look in the mirror and see if you pulled your neck up behind the ears or if you pulled your neck together in the middle. Depending on which one you like the look of in the mirror then you would have your answer...

Gianfranco Frojo, MD · Answer

I would recommend a necklift. Cool sculpting does not work; it can actually stimulate production of bigger fat cells (paradoxical adipose hyperplasia). This is a common undesired outcome after CoolSculpting. I would recommend seeing a board-certified plastic surgeon (American Board of Plastic Surgery) to address your issues.

Arthur Dean Jabs, MD, PhD, FACS · Answer

Cool sculpting can lead to paradoxical adipose (fat) hyperplasia (increase). Depending on where the fat has enlarged, above the platysma muscle or below or both, can be determined by an exam which will then guide the treatment. You may be able to get away with just liposuction of the area or you may need the fat beneath the platysma (the thin muscle that runs from your collarbone to your jaw) reshaped. It sounds as if you have confirmation from 4 surgeons that the deep fat needs to be addressed.
Find someone in your area you trust and have it done.

All the Best,

Dr. J

Jigar Sitapara, MD · Answer

Good afternoon from Maryland!

Over the last few years I have been seeing more and more patients with similar concerns after these types of non-surgical treatments (one patient did cool sculpting, kybella, RF microneedling, and liposuction before seeing me for their final surgery). The trouble with the neck is that the bulky contents are in two different layers. There is the fat directly under the skin which would be addressed with liposuction (with or without Vaser) and this the layer of fat that was targeted with the CoolSculpting. Under that layer of fat is the platysma muscle (think of it like a sheet going across your whole neck) and then there is fat/muscle/glands under that sheet of muscle. If you were to get liposuction alone, you would be only treating that outer layer of fat. If you wanted a more complete treatment where all layers of fat, muscle, glands were addressed, that would be a deep neck lift. It's hard to know who carries a majority of their bulk above that platysma muscle or below it, without physically feeling your neck. All in all, it appears like you would get some improvement with liposuction, but it would be a better and longer lasting result if you went the deep neck route.

I hope that helps! As always, an in-person consultation will help you find the best surgeon for you.

Wishing you all the best!
Dr. Sitapara
Prime Facial Plastic Surgery

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photograph. As far as I can tell, the characteristics of the volume under the chin have some hereditary elements. This volume is situated deep to the platysma muscle and is essentially composed of centrally situated fatty tissue, the volume of the digastric muscles lateral to the fatty tissue, and, lateral to the digastric muscles, the lower part of the submandibular glands.

The deep plane neck lift intervention can address all these elements, as well as some of the superficial fatty tissue. The area where the superficial fatty tissue would be more relevant to control is in the jowl region, which is slightly prominent. Together, these elements can give you a significant increase in jawline definition and a slimmer neck contour in the upper part.

Liposuction can also produce changes, but it is limited to the fatty tissue situated under the skin.

Zachary Farhood, MD · Answer

Sounds like you may be experiencing paroxysmal adipose hypertrophy (PAH) following coolsculpting. A Deep plane neck lift will best address your submental region.

Stephen Prendiville, MD · Answer

The answer will depend on a consultation and an exam, but your solution is going to be surgical.  Whether a deep neck lift or a deep plane facelift is most appropriate depends on the degree of skin laxity present/

Jacob Tower, MD · Answer

Hello, hope you are well. Thanks for posting your questions and photo. The central bulge under your chin is most likely subplatysmal fat. Removing it requires a deep neck lift with a small incision under the chin. There is no non-surgical procedure to remove subplatysmal fat. Fat grafting has no role in the treatment of the neck fullness--there may be something that was lost in translation with that consult. Liposuction only address the fat directly under the skin (subcutaneous fat). Hope this helps!
Cheers,Dr. Tower

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial and neck photographs from all angles. From the one very limited photograph, you appear to have significant fat deposits located both above and below the platysma muscle, which is going to require a deep neck lift procedure. A platysma plasty is performed after the deep neck fat has been removed from below the platysma muscle itself. If you're less than 45 years of age, no skin removal is required.

Michael S. Kluska, DO · Answer

Unfortunately, you have developed an inflammatory response from the cool sculpting. That being said, vaser liposuction may not be able to treat this, and you would benefit greatly from a deep plane NECK LIFT. This would allow for direct excision of the hardened fat above the muscle, and then address the fat below the muscle as well.

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