It is not surprising that most patients are concerned about neck liposuction incision, which inevitably leads to scar. Nonetheless, not all scars are bad, particularly when they are made remarkably small and are placed in discreet areas, allowing them to blend well into the background.
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has explained the two neck liposuction incision placements and how the patient’s underlying anatomy and fat location determine the ideal approach.
- Single incision under the chin
A small round incision is specifically placed within the skin fold for optimal scar concealment. This incision technique is only suitable for patients with minimal to moderate amount of fat that is mainly limited to the center of the neck.
- Two additional incisions behind the ears, ideally in the earlobe crease
Apart from the incision beneath the chin, patients who need more correction—i.e., they have a full neck fat that extends beyond the center—will need additional incisions behind the ears. This technique allows the surgeon to “attack” the excess fats from different directions, a technique that is tied to smoother and more natural results.
In fact, best results are usually obtained with the additonal incisions behind the ears.
Aside from the incision placement, another critical issue is how much fat remains afterwards. Contrary to popular belief, great resutls are achieved when enough fat is preserved during surgery, as it serves as a “carpeting” that will prevent the platysma muscle from becoming visible neck bands.
The ideal amount of fat that is removed during surgery also depends on the patient’s skin elasticity. Therefore, someone who is relatively young and possesses good skin shrinkage generally tolerates a more aggressive approach than someone with reduced skin elasticity.
For instance, Dr. Smiley has recently performed neck liposuction in which around 300 cc of fat was removed. While it may sound an excessive amount, for this particular patient it was the right volume due to the extent of her full neck and her good skin shrinkage, which could be attributed to her young age.
However, the same amount of volume might be considered “too much” when the surgery involves older patients who generally have reduced skin elasticity, unless a concurrent neck lift (or skin excision-based surgery) is performed as well to prevent sagging appearance.
Facial aging happens differently from person to person. For instance, some people have sagging skin that is mostly concentrated around their eyes, while others have most of the bagginess along their jaw line and neck.
Nonetheless, facial aging often affects multiple areas almost to a similar degree and thus facelift and neck lift are commonly performed together. Combining them in one surgery also makes sense because the standard facelift incision is simply extended into the nape.
This is an incision pattern used in facelift and neck lift approach. Take note that all scars are hidden.
(Note: Standard facelift entails an incision that starts inside the hairline at the temple area, which then curves in front of the ear and behind it. And with a concurrent neck lift, the scar is slightly extended into the nape, specifically behind the hairline, to hide any surgical stigmata).
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated on Snapchat the rejuvenation effects of this combo approach, particularly when combined with a SMAS lift technique.
SMAS refers to a soft tissue layer found beneath the facial skin and fat. During facelift, Dr. Smiley not just removes the loose skin and elevates the remaining skin; he also tightens this underlying structure.
To further ensure a congruous result, he also tightens the platysma muscle of the neck by using internal sutures, which essentially act as a sling.
The compounded effects of these techniques are tauter jawline, restored volume of the cheek, more youthful chin-neck transition, and smoother neck appearance.
The direction of pull also plays a critical role in facelift and neck lift. The correct vector can create a tauter jawline and restore the youthful plumpness of the cheek, whereas an incorrect one can spell disaster—e.g., wind tunnel effect or overly tight mid face, lateral pleating of the neck skin, and skin bunching around the earlobe.
In a recent Snapchat video, Dr. Smiley says the correct direction of pull is 45 degrees angle, adding that in no way that the soft tissue should be pulled in a blunt horizontal or vertical manner to avoid any telltale sign of surgery.
The ideal neck liposuction incision placement will depend on the extent and location of excess fat. Nonetheless, all efforts are made to position the scar, usually 2-5 mm diameter, in concealed areas such as beneath the chin and behind the earlobes.
Renowned Inland Empire plastic surgeon Dr. Tarick Smiley regularly performs neck liposuction and other surgical enhancements whose aim is to create a more youthful, smoother transition between the neck, chin, and jaw line.
Recently, he performed extensive neck liposuction on a female patient with a full-looking neck. Hence, instead of the usual single incision placed behind the chin (specifically at the natural skin fold for optimal scar concealment), he also created a pair of incisions behind the earlobe.
With three small incisions, Dr. Smiley says the excess fat can be accessed from different angles, leading to smoother and more natural results.
To further promote smooth results, he moved the microcannula (a blunt-tipped hollowed tube) back and forth in a fan-like motion and avoided staying too long in one area so as to prevent surface irregularity.
Extensive neck liposuction may involve as much as 300 cc of fat, while a minor correction may just remove as little as 20 cc. Contrary to popular belief, the success of liposuction boils down to how much fat remains after surgery, as opposed to how much the surgeon removes. After all, over-correction can lead to “cosmetic” disasters—e.g., surface irregularities, sagging appearance, and visible platysma muscle.
The platysma muscle along the neck may show through the skin if all the fats, which serve as a carpeting, are removed during surgery.
In general, neck liposuction, especially if it involves large amounts of fat, is only reserved for younger patients who typically have good skin shrinkage, whereas neck lift (excision-based) is more suitable for individuals with loose skin. Occasionally, they are combined in one surgery to achieve the most desired results.
After neck liposuction, Dr. Smiley says he recommends the use of chin strap (compression garment) for at least a week to help remodel the skin and to keep swelling at a minimum.
Face and neck lift with fat transfer can provide a holistic facial rejuvenation effect by correcting not just the sagging skin and deeper soft tissue, but also the volume/fat loss that comes with aging.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate face and neck lift with fat transfer performed in a female patient with advanced signs of facing aging.
Dr. Smiley has described the patient’s facial aesthetic issues, which all required a customized approach to achieve the most rejuvenating effects without causing surgical stigmata such as flatness of the cheek, visible scars, and overly pulled countenance.
- drooping of the cheek
- loss of volume in the cheek, particularly the area between the mouth corner and the nostril
- recessed and sagging chin that almost disappeared from the neck
- appearance of jowl
- “heavy” neck due to excess skin
To improve the aforementioned aesthetic issues, Dr. Smiley used an incision pattern starting from the forehead area (behind the hairline) that went behind the tragus (small bump in front of the ear) and behind the earlobe and into the hairline at the nape; hence, all the scars would be hidden.
Afterwards, the celebrity plastic surgeon separated the skin from the SMAS, a layer of soft tissue that extends from the neck to the temple area. The SMAS and the platysma muscle of the neck move as a single unit, said Dr. Smiley in a recent Snapchat video.
“When doing the lifting, we have to do the deep lift, as a skin-alone lift is not enough to support the new elevated contour, Dr. Smiley further explained.
A deep lift also provides more natural results as the skin receives no or very little tension during wound closure, thus eliminating the risk of windswept appearance, overly flat cheeks, and other telltale signs of facelift, said Dr. Smiley.
Elevating the deeper layers of the soft tissue created immediate rejuvenating effects to the patient—i.e., her jawline appeared more defined, the upper cheek regained its “youthful plumpness”, and the angle or transition between the chin and neck was smoother.
To further improve the neck contour, Dr. Smiley created a small incision beneath the chin to access and tighten the platysma muscle towards the middle and side, thus creating a “sling effect on both directions.”
Because face and neck lift alone does not address facial volume loss, the patient also received fat transfer to the cheek, particularly the area between the nostril and mouth corner. The adjunct procedure was also used to create a smoother transition between the lower lid and the upper cheek.
While neck lift with liposuction is a highly individualized procedure, it generally refers to excess fat removal combined with platysma muscle repair. However, older patients (i.e., 60 years and above) may need additional contouring in the form of lower facelift, which basically lifts up the skin.
It is important to note that the success of any facial plastic surgery boils down to meticulous physical or anatomical examination. The idea is to determine the underlying cause/s of the problem to come up with the best solution.
Dr. Tarick Smiley, a renowned Orange County plastic surgery expert, has explained the basic components of neck rejuvenation surgery.
- Liposuction-alone surgery
This is only reserved for patients with good skin elasticity, meaning it can snap back without any problem after removing the excess fat responsible for the appearance of “double chin” or excessive fullness of the neck. Hence, the vast majority of patients are relatively young (late thirties and forties).
It involves a small round incision beneath the chin, precisely made at the natural skin crease for optimal scar concealment.
- Neck lift with liposuction
Some patients have a poorly defined neck contour due to excess fat and loose platysma, which is a muscle that extends from under the chin all the way down to the neck and collarbone.
This approach starts with the creation of small incision beneath the chin to remove the excess fat. Then, the same opening is used to access the splayed muscle so it can be tightened in the midline with the use of internal sutures.
Basically, a lower facelift elevates the sagging skin (and remove any excess) that contributes to the appearance of jowl. In doing so, the patient can expect a tighter and more defined neck and jawline, and possibly improvement in the corners of their mouth.
As a more extensive approach, this favors older patients who typically require more correction. This may also serve well massive weight loss patients who are left with redundant skin, which not just affects their body but also their face and neck.
Poor neck lift results are generally caused by over-resection of skin and/or fat. Hence, the goal is not about removing optimal amounts of tissue, but more importantly, leaving behind enough to ensure that the results look natural and the scar will not spread or migrate.
Leading Orange County plastic surgery expert Dr. Tarick Smiley explains how he prevents poor neck lift results:
- Use the right incision pattern based on the underlying problems and anatomy.
In an attempt to minimize scarring, inexperienced surgeons use shorter or fewer incisions despite the presence of large amounts of hanging skin. It is important to note that for most neck lift patients with loose skin, a small incision behind the ear, specifically within the natural folds of skin, is used.
To further create a smooth and youthful angle between the chin and neck, a small incision is placed underneath the chin.
Interestingly, the use of correct incision pattern based on the underlying anatomies (even though the incisions seem long and extensive) results in favorable scars as they remain hidden within the natural skin folds.
- Over-resection of skin and fat must be avoided at all cost.
Poor neck lift results due to over-correction—i.e., removing too much skin and/or fat—is remarkably difficult to improve with a revision surgery. In fact, the patient might be advised to just wait for the skin to relax and “settle.”
However, qualified surgeons (i.e., they are board certified and are performing facelift and neck lift on a regular basis) know how to avoid the signs of over-corrected neck lift—e.g., skin asymmetries, gaunt appearance, and visible platysma muscle.
Skilled surgeons know that there should be at least 5 mm of fat beneath the skin to prevent surface irregularities and visible platysma muscle; hence, they will avoid over-aggressive liposuction.
- Tighten the weak platysma muscle.
In young people the platysma muscle is tight but with aging it becomes weak and splayed, leading to the appearance of vertical neck bands. This “cosmetic” problem can also be a result of massive weight loss.
To create a smooth, youthful angle between the chin and neck, the platysma muscle needs to be tightened in the midline with the use of internal sutures. This is possible by placing a small incision underneath the chin.
Aside from correct scar placement, proper wound closure will also play a critical role to prevent surgical stigmata. The goal is to eliminate tension on the skin to preclude the scars from migrating or “pulling.”