Chin and Neck Revision Liposuction

I have discussed on the ExpertLiposuction website that I approach the neck and chin area in one of two ways.

1. Either only liposuctioning the central neck called the submental region
2. Liposuctioning the entire neck – In these cases if there is fullness in the jowl area it is important to carefully bring this down and blend it with the jaw line.

It is very important prior to surgery to decide if the patient is a candidate for submental or the entire neck. The most common mistake seen is when the patient only has the central neck or submental area done through one midline incision point instead of the whole neck through both one central incision and 2 lateral incisions under each earlobe. In these patients, the central neck skin tightens and retracts yet the lateral neck doesn’t and there is no definition of the lateral jaw line. There is commonly an unnatural look to the way the central neck has lifted in relation to the lateral neck. This patient ideally should have had the entire neck done. The remedy for this is to now blend the retraction of the central neck or submental skin with the lateral neck and jaw line by well done liposuction from the laterally placed incisions under each earlobe.

On the converse, a patient may have had liposuction to the entire neck both centrally and laterally when they should have only had submental liposuction. In these cases if there is only fullness centrally and the lateral jaw line is aggressively liposuctioned it could result in retraction to that lateral thin skin and an unnatural appearance to the lateral neck or jaw line skin. This can be a little more difficult to approach but fat transfer to the lateral neck or jaw line can help establish a more natural contour.

Another common mistake is aggressive liposuction to the neck in an individual with poor skin elasticity. Whenever I evaluate a patient for neck liposuction, I always carefully evaluate their skin elasticity. A great candidate is one with good elasticity and fullness. A poor candidate is one with poor elasticity and loose hanging skin. This latter patient is most likely better served by a surgical lifting procedure (possibly lower face/neck lift). If one liposuctions this type of patient, the skin will retract and tighten but will likely do so in ways that create a more wrinkled, older look. However, most patients are somewhere in between and a very careful determination should go on in the consultation with regard to whether to proceed with liposuction. At some point (usually for most patients around the age of 50-60) the elasticity of the neck skin has reduced enough that I choose not to proceed with liposuction due to increasing risks of uneven pullback of the skin. When I see a patient in whom this has occurred from previous liposuction, I will usually suggest they consult with a surgeon for a possible neck lift, or if it is not too bad, a nonsurgical tightening procedure such as Thermage may be beneficial.