Facial and Neck Liposuction
Liposuction is one of the most common cosmetic surgery procedures and has become much easier over the past 20 years. Unlike body liposuction where large volumes of fat may be removed , the procedure is much more conservative in the head and neck. Most patients do not have large areas of fat in the head and neck and therefore much less fat is removed. Where quarts of fat may be removed from the body, the amount of fat removed in the head and neck is measured in “tablespoons”. The main areas in the head and neck for fat deposition are the jowls, the area under the chin, and the neck.
Figure 1. shows common areas of fat deposition in the facial region.
The most common misconception about neck liposuction is that it will tighten lose neck skin. Many patients present for the consult and have a large “turkey gobbler” area of excess skin. Even if there is fat under the lose skin, removing the fat will only serve to accentuate the lose skin and make it look worse. The bottom line is that if a patient has excess skin under the chin and neck, they will need a facelift to correct this.
Having said this, liposuction of the neck and chin (submental region) can be very effective in the proper patient. This is usually a younger patient with fat deposits under the chin and without significant excess skin. In these patients, removing some of the excess fat by conservative liposuction can make a huge difference in the patient’s profile. The younger the patient is, the more the skin will tighten up after removing fat, as there actually is some degree of skin tightening in most patients. The jowls, cheeks (to a lesser extent) and neck can also respond to liposuction. It is important to remember that liposuction is not treatment for obesity but rather for genetic fat deposits that are resistant to generalized weight loss.
Head and neck liposuction can be performed with local anesthesia or with IV sedation. The area is sanitized and a dilute solution (tumescent anesthesia) of local anesthesia and epinephrine is used to inflate the tissues to be liposuctioned. This tumescent solution not only numbs the area but also decreases bleeding and facilitates the actual liposuction procedure. A tiny puncture is made in a skin crease to hide any scar, and the liposuction cannula (a thin metal, straw-like instrument) is inserted under the skin . The cannula is briskly moved back and forth through the excess fat and the fat is emulsified into a liquid that is suctioned out. It is important not to over treat an area because removing too much fat (especially in the neck and under the chin) can cause very visible irregularities under the skin. The treated area will usually stay numb for several hours after the procedure, so pain is not a common problem.
After the procedure the patient is given a compression dressing (Jaw Bra) to wear for several days. Depending upon the amount of fat removed and the amount of excess skin the dressing may be worn for 5 days continuously and at night for the next week. For most patients, this type of liposuction is a weekend recovery unless they bruise, which extends the recovery from a cosmetic standpoint.
Figure 2 shows a patient treated with liposuction only of the chin and neck regions.
Buccal Fat Pad Removal
All humans have walnut sized collections of facial fat called the Buccal Fat Pads that lie in the cheek. In patients that desire to have their face “slimmed” the buccal fat pads can be reduced at the same time (or in place of) the liposuction. This is done by making a small incision inside the mouth, next to the wisdom teeth and the fat pad is teased out of its position and conservatively reduced.
Icing on the Cake (Chin Implant Surgery)
Another means of dramatically complimenting the liposuction procedure is to place a chin implant in the appropriate patient. Many patients with submental fat also have a retrusive profile from a weak chin. By removing some of the chin and neck fat with liposuction and simultaneously placing a chin implant, the result is made better than doing either procedure by itself.
The chin implant can be placed from the inside of the lower lip so no surgical scar is visible. The recovery for chin implant surgery is about one week.
Figure 3 shows a patient treated with liposuction and a simultaneous chin implant.
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Joe Niamtu, III DMD