Improving the neck and jawline contour can be accomplished through several ways. As we age, we can develop excess fat in our neck, our neck structures descend, and the skin and muscles become lax. Neck liposuction treats only the excess fat in the neck. However, it has been noted by many surgeons over many decades that removal of subcutaneous neck fat results in not only improved shape from the diminished fat, but also in neck skin tightening. To some surprise, this remains true in older people as well as younger people. Here we provide details into our preferred methods that take advantage of precise execution of classic tumescent liposuction techniques to improve the neck and jawline contour.
17 Neck Liposuction: The Classic Technique
Neck liposuction is a powerful technique that can enhance the jawline and restore a youthful contour to the neck.
17.1 Patient Evaluation
Several attributes of the neck require examination to accurately assess its aging. These include the notation of excess skin, quality of skin elasticity, subcutaneous fat, subplatysmal fat, presence of platysma bands, prominent submandibular glands, and finally the architecture of the mandible, most notably the position of the pogonion.
When considering non-excisional procedures, skin quality is perhaps the most important factor. There is no specific test that will allow the surgeon to judge the extent of skin retraction (or tightening) that can be achieved from any particular non-excisional procedure. We caution relying on industry photos or paid speakers to set expectations. Rather, the surgeon needs to perform these procedures, in the setting of full disclosure that extent of skin tightening is unpredictable and that if not enough tightening is seen to meet the patient’s desires, an excisional procedure may be necessary. The authors have been very pleased with patient satisfaction following “original” neck liposuction and in over 1000 patients treated, very few have desired an immediate excisional procedure. However, it is common for these patients to return years later for more extensive neck rejuvenation.
17.2 Preoperative Planning and Preparation
The primary objective of the preoperative plans is to resolve the patients’ goals with their anatomy. Liposuction is capable of significantly reducing subcutaneous fat and creates a range skin retraction from modest to impressive by undermining and redraping the skin.
Younger patients typically have more elasticity to their skin; however, we have observed excellent results in patients in the 50s, 60s, and early 70s.
Subcutaneous fat can be distinguished from subplatysmal fat by palpating the submental or submandibular regions and asking the patient to swallow. Fat that does not “pull away” is usually subcutaneous.