Is Neck Lift / Liposuction my only option? (photos)

Question

I consulted with a plastic surgeon who recommended a neck lift and liposuction. I live an active life and don’t have much downtime. I also scar easily. Is there anything I can do like coolsculpting or something similar to achieve similar results or am I lying to myself? I don’t want to waste money if it isn’t going to have a significant difference as I’ve already wasted a lot on RF/Hifu/ meso fat injections. I want to be pretty for my graduation in December. Please advise.

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Jonathan Kulbersh, MD · Answer

Thank you for posting your question and photos. To address the areas of concern you’re referring to, it is likely that a neck lift combined with facial liposuction would be the best approach. During this procedure, small incisions are used to tighten the deeper tissues and muscles along the neck and jawline prior to tightening the skin. Liposuction is often used during surgery as well to remove excess submental fat and create a well-defined jawline.

Though patients should expect approximately 7-10 days of recovery time, the results from a neck lift may last for ten years or more. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can go over all of your options and inform you of the expected recovery times for each.

Bhupendra C.K. Patel, MD, FRCS · Answer

On cursory examination of your two lateral photographs, your plastic surgeon is giving you the correct advice. 
Your neck needs more than just a "neck lift", in that one needs to work on the superficial fat as well as the deep fat (fat that is deep to the platysma centrally). In addition, your digastric muscles may also need to be operated upon. This is always combined with liposuction and can give you a very pleasing result. 
The incisions are usually very small behind the ears and under the chin you will have an incision about 2 to 2.5 cm long: these heal well and can also be treated for any redness, etc. 
I see a lot of patients like you who have been through a series of HIFU, RF, mesotherapy (Kybella, etc) with minimal improvement. Everyone is looking for the magical "no surgery" approach and wasting a lot of money (and time). It is best to decide how much of an improvement you are seeking and then go for the best option. Your surgeon may also use a device like Renuvion to get further tightening of the skin and subcutaneous tissues (in addition to the deep surgery). This is done during the surgery.
Finally, we always advise our patients to be at the best body weight possible so the jawline and neck can be sculpted properly.

William Portuese, MD · Answer

More information is needed, such as your height, weight, and age to make the best decision. It's very important to be height/ weight proportionate with a BMI of less than 30. Liposuction will be only minimally effective because you have fat compartments located both above and below the platysma muscle. The fat is going to be much thicker below the muscle than the fat above the  muscle, therefore a necklift is required. A platysma plasty is also performed once the sub-platysmal fat has been removed. Noninvasive treatment simply are unable to address removal of both compartments of fat and tighten the muscle, and Therefore surgery is your best option. While the visible swelling and bruising lasts two weeks to subside, full healing after this procedure is going to be several months. The procedure is performed under general anesthesia as an outpatient procedure.

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