Refinements in Neck Liposuction
My premise was to maximize results by using different instruments, that have the capability to carve soft tissue effectively and give substantive improvement to this common aesthetic problem.
Methods/Technique: The cannulas I designed feature four rows of one mm holes, which remove small, even-sized particles of fat leaving behind an attractive, even layer of fat which is the foundation of a good result.
Each hole has a small barb or tooth, which improves the efficiency and allows “carving” of fibrous tissue, particularly near the mandible angle. The barbed tips stimulate the underside of the skin, leading to maximal skin contraction. They come in 2.1 mm and 2.4 mm diameter and are manufactured by Tulip Medical (no financial interest). The tip is bullet-shaped which allows entry through a 16 gauge needle puncture, which tends to leave no mark.
The procedure can be done under IV sedation (or general anesthesia) or with oral sedation and local anesthesia. Initial entry is via two punctures in the submental area and using the 2.4 mm cannula to address the central submental area and feathering posteriorly. Separate entries are then made laterally and posteriorly allowing the 2.1 mm cannula to criss-cross the submental area giving a more complete result. A network of fibrosis is created, which supports the neck structures. The cannulas can then be angled posteriorly to address the submandibular area and below the angle.
Since the 16 gauge punctures do not leave marks, direct entry into the jowls is possible, either posterior or anterior to them. This adds an important dimension to facial shaping not commonly done in standard liposuction due to the attendant marks. The liposuction can be done manually, or there is an adapter available to allow the use of power-assisted apparatus. The surgery typically takes less then 1 hour.
Results/Complications: This technique results in a thorough re-shaping of the neck/jowl area with definition of the mandible outlining the border between the mandible and the neck with an appropriate shadow. In the right patient, there is ample skin tightening leading to an elegant result.
Complications include bruising and swelling which usually resolves promptly. Induration of the submental area can occur necessitating massage and patience . If the neck skin is lax, irregularities can form which could be objectionable despite other improvements. A temporary marginal mandibular palsy can result if extensive work in the angle is needed.
Conclusion: This is an excellent procedure which requires minimal capital outlay and can benefit a large number of patients, from younger ones with early changes to older ones with reasonable skin elasticity. A great advantage is the favorable aging of the cervical area following this surgery.