This is another case example of neck lift surgery using a combined technique that involves cervical liposuction and platysmaplasty surgery. We have discussed elsewhere on out site the virtues of performing neck enhancement with these combined procedures, but case examples are a great way for potential patients to see real life results in other patients.
Case Example Neck Lift Surgery
This female patient from San Diego desired to have enhancement of her neckline for unwanted fullness under the jaw region. She felt as if this was giving her a prematurely aged look – despite feeling quite young on the inside. However, she did not wish to undergo a more extensive, formal facelift/necklift procedure. Part of this decision was based on the fact that facelift surgery would necessitate longer incisions around the ear with a more involved healing process. This is actually a very common concern amongst patients considering neck lift surgery. They just don’t wish to have a more extensive surgical procedure that includes making the usual incisions all around the ears.
As an alternative to performing a formal facelift/necklift operation, we discussed the option of doing combined neck (also referred to as cervical) liposuction and platysmaplasty surgery. The neck liposuction procedure would involve suctioning out the excess fat under her chin while the platysmaplasty surgery would involve tightening the neck muscle just underneath the fatty tissue layer. The goal was to create a more defined neckline that appeared more youthful. In addition, her desire was to achieve a more refined looking jawline in the process.
Skin Elasticity & Neck Liposuction
One of the most important considerations in this type of case is skin elasticity. This refers to the rubber band-like quality of skin where it ‘snaps’ back after pinching or pulling it. As patients age, they lose more and more of this skin elasticity. This particular patient had skin that still had some reasonable degree of elasticity – meaning, it still had a good rubber band-like quality that would allow it to snap back. This is a critical element in the decision making process to undergo neck lift surgery using this technique because it relies on the skin shrinking upward to the newly created neck contour. This is shown in the adjacent photo diagram. When the fat is suctioned out under the chin, what happens to the overlying skin? Since neck liposuction does not involve cutting skin out, it relies on the skin moving upward to create a new defined neck contour. This is indicated by the red arrows showing the direction the skin is required to go in for an optimal surgical outcome. This process is like a deflating balloon as the air is taken out. If the skin does not have this elastic quality remaining, the neck would simply hang or drape down after the fat was removed.
After examining this patient in the office, we determined that her skin, indeed, had sufficient elasticity making her a candidate for neck liposuction and platysmaplasty. In patients who are much younger – 20s and 30s – having sufficient skin elasticity is not much of a concern. As patients age into their 40s and 50s, skin elasticity becomes an increasing concern when considering this particular surgical technique. In patients who have only marginal skin elasticity left, this technique of neck liposuction and platysmaplasty may not be in their best interest as the skin may just hang down more after surgery. In these cases, a formal lower facelift/upper neck lift with incisions around the ears is likely necessary in order to pull the excess skin back and up.
Liposuction & Platysmaplasty Surgery
This patient elected to have the combined liposuction and platysmaplasty surgery performed from underneath the chin region.
Her surgery was done under an anesthetic in our own accredited ambulatory surgery center. She was put comfortably to sleep and underwent removal of the excess fat under her chin along with tightening of the platysma muscle through the same small incision beneath the chin. The operation took about one and a half hours to complete. She was then awoken and sent home a relatively short time later.
She knew going into the operation that this approach relied on her skin elasticity bringing the neck skin back up during the healing process. If the skin elasticity turned out to be insufficient, which would not be fully known until the healing process occurred, her skin would, unfortunately, just hang there. It would then necessitate a second operation to go around the ears and lift the skin as is done in a formal lower facelift/necklift procedure. Fortunately for this patient, her skin ‘read the rulebook’ as they say and shrunk to accommodate the areas where the fat was removed.
As you can see from the photos provided here, there has been a somewhat dramatic change in her submentum (area below the chin) and jawline.
Before and After Photos
As you can see from the front view, her neckline and jawline now have much better definition. This can be appreciated by looking at the shadows under her chin that were not as defined prior to surgery because of the excess fat and skin wrinkling. Now her neck appears much smoother with an overall more youthful look. On her oblique view, you can also appreciate how much improvement was made with the liposuction and platysmaplasty surgery. On this angle one can see how the skin has, indeed, pulled itself upward under the jawline to create more definition. On her profile view, the new angulation that was created along her neck is quite obvious. Whereas before her neck was much fuller, it is now more angulated and youthful. Keep in mind that no skin was actually cut out from under the chin. Once the fat was suctioned out and the muscle was tightened up under the chin, the skin (that was once bulging forward) shrunk upward and back. This only occurred because she had sufficient elasticity that allowed this process to take place. These results also did not just appear within weeks of having surgery. This type of stable result took many months to evolve after the neck liposuction and platysmaplasty were performed. In the meantime, patients are asked to wear a compression bandage at nighttime while sleeping to encourage the skin to shrink faster. In addition, some patients are told to massage the skin to further help optimize the surgical results. In the end, these type of surgical results are possible without having to undergo a more extensive lower facelift/necklift procedure with certainly more scarring and the potential to have an even longer recovery .
Dr. John Hilinski has either authored or reviewed and approved this content.