I have always hated how my neck looks. What can I do about it?
For many patients, dissatisfaction with the appearance of the chin and neck is a lifelong problem. It occurs in men and women alike. It persists whether your weight is high or low, and typically is something that has been a concern about your appearance your entire life. It is not something that necessarily started as you got older.
The chin and jawline are common areas of aesthetic concern. The loss of chin definition occurs as part of the natural aging process, but can also result from a lack of development of the bones of the jaw (i.e., mandible). A youthful neck has a distinct inferior mandibular border with no loose or over-hanging jowl. Excess jowl fat influences perceptions of age and attractiveness, and its positioning is an important component of facial rejuvenation. Other parts of the youthful neck contour include a sharp neck angle; definition of the sternocleidomastoid muscles; and the absence of fine or coarse neck skin wrinkles.
Fortunately, there are a number of different options available. Neck fat is currently treated through traditional aesthetic surgical procedures performed under general anesthesia, targeted liposuction, ultrasound and radiofrequency procedures, and lipolytic drugs suck as Kybella. A physician survey from 2012 found that liposuction was used in 81 percent of jowl fat reduction procedures, making it the most commonly performed treatment for this area. Currently, combination therapies, such as liposuction in combination with an energy based device, such as Vaser, is one of the most popular methods to treat the skin and fat of the neck.
Even better, most of the techniques that we currently use at Ver Halen Aesthetics provide for minimal down time, minimal incisions, and minimal surgery. But that does not mean that we compromise on your results! Rather, surgical techniques and devices have improved to the point that we can provide impressive, yet natural appearing results, with tiny incisions and minimal recovery time. In fact, many procedures can be performed without needles, scalpels, or sutures.
Kybella, or “Mesotherapy”
Deoxycholic acid is a naturally produced substance, typically made in the human body as a part of bile salts and acids that break down fats in the intestines. Starting in the 1970’s, this substance was purified and used as an injection to break down fat in the human body, also referred to as “mesotherapy”.
Kybella injection may be an appropriate treatment for some patients presenting with neck and jowl fat. In a 2006 survey, injection of jowl fat with phosphatidylcholine and other compounded formulas resulted in fat reduction and skin retraction according to 21 percent (16/75) of physicians. Kybella is an approved adipocytolytic (or “fat reducing”) treatment for the reduction of submental. However, recent studies have shown that it may also safely be useful in treating other areas of facial fat. When injected into subcutaneous fat, deoxycholic acid disrupts the fat cell membranes, and a subsequent inflammatory response clears the injection site of cellular debris and liberated lipids.
In general, a dose of 2 mg of Kybella is used for every square centimeter of neck and jowl fat. Depending on the size of the treatment area, Kybella injections of 0.2 ml spaced every 1.0 cm apart or 0.1 ml spaced 0.50 to 0.75 cm apart are placed. The improvement in your appearance is measured at 6 months or more after the last treatment in person. On average, patients will require 1.8 treatments, but sometimes this can take 3 to 5 treatments. The majority of patients (98 percent) will experience an improvement in neck and jowl appearance. Common side effects include injection-site edema, numbness, tenderness, and bruising, although injection-site marginal mandibular nerve paresis and alopecia (or hair loss) can also occur. However, these events typically resolve without any lasting issues. The main side effect is generally swelling in the area of injection that can last up to two weeks. Other patients may experience bruising that can last up to a week.
Chin liposuction has been been around for decades, but the way that it is currently used is much more modern. Chin liposuction allows a patient to use all of the most up-to-date surgical and non-surgical technologies, but in a minimally-invasive combination of treatments that allows for a reduced recovery time, reduction in potential adverse events, and the best combination of fat reduction and skin tightening.
What does this mean in non-professional terms? First, the largest device used is 3 milimeters in diameter. By comparison, the average human fingernail on the pinky ring is about 1 centimeter in width. So this means that the largest device used is less than 3/10 of the width of your smallest fingernail.
How is this possible? We are able to use a small device to deliver thermal and acoustic energy to the subcutaneous areas of your chin and neck. This will both help to remove fat in these areas, but also the delivery of thermal energy will help induce collagen formation in the area, which in turn will help to tighten and firm the overlying skin. Using a tiny electrical spark, physicians can reduce unwanted fat, stimulate collagen and elastin formation, and reduce and reverse the signs of aging.
What is the ultimate goal? Energy-assisted chin liposuction will help to permanently remove or reduce unwanted fat, fine lines, wrinkles, scarring, tighten sagging skin on your neck. The results are only comparable to much more invasive surgical procedures. To put the prices into perspective, the cost of Fraxel laser skin resurfacing is $1,800 – $2,500 and a facelift is $7,200 – $10,000. Chin and neck liposuction starts at about $2,000 and can go up to over $6,000, depending on additional treatments that are needed.
Our energy-assisted liposuction procedure is not just applicable to the chin and neck. In general, it can be used anywhere in the body where either fat reduction or skin tightening is a concern. We have experience using this technique in the following areas:
- Hooded Eyelid Lifting
- Under Eye “Bags”
- Crow’s Feet
- Forehead Lines
- Nasolabial Fold
- Neck Lines
Our technique has a number of advantages compared to surgery. These include:
- No scalpels used
- No stitches
- No risk associated general anesthesia
- Less downtime compared to surgery
- No thinning of skin
- Induces collagen growth
- Significant cost savings
- Natural results
- Immediate results that improve up to 12 months after the procedure
Many patients want to know how long the results will last. The results are permanent. Although energy-assisted chin liposuction does not stop your natural aging processes, you should still see lasting results for years. In order to maintain your results, you will want to maintain a healthy lifestyle, avoid smoking, excessive alcohol consumption, and prolonged sun exposure.
One of the most important factors is deciding whether or not you are a good candidate for chin liposuction. As with most cosmetic procedures, if you are pregnant or nursing you should avoid this treatment. Otherwise, most patients who are otherwise a suitable candidate for a procedure performed under local anesthesia, are an appropriate candidate for energy assisted chin liposuction.
If you choose to have this procedure, your case will be reviewed by a physician to ensure that you are a good, appropriate, and safe candidate for chin liposuction. Prior to the day of your procedure, you will have a preoperative visit. This will include a history and physical, preoperative photographs, and prescription of your medications. In certain instances, this can occur on the same day as your procedure. Keep in mind that while you CAN drive yourself in to your procedure, you WILL REQUIRE A CONSENTING ADULT TO TAKE CARE OF YOU FOR THE FIRST 24 HOURS POSTOPERATIVELY. If you cannot arrange for someone to help you, we can help arrange for home nursing care.
On the day of your procedure, it is best to arrive with clean skin, without any make-up on the treatment area. In general, these procedures are performed awake, although you can request general anesthesia if you desire. A numbing cream is usually applied on the treatment area to first anesthetize the area. When the medicine has had time to take effect, we will use a small, blunt device to bathe the subcutaneous fat with a mixture of numbing medication. You may feel some pressure or “pinching” in the treatment area, which may be uncomfortable and slightly painful. This treatment time is usually about 30 minutes.
Immediately after the numbing, we will begin the process of using laser, ultrasound, or radiofrequency energy to start heating the skin, and liquefying your subcutaneous fat. After this, we will use a small, hollow tube to suction the remaining fat from beneath your chin and neck skin. Typically, the entire process will last 60 to 90 minutes.
At the end of this, we will place you in a postoperative dressing. You will experience some leakage after the procedure, but this is only temporary. It is best to simply reinforce your dressings with additional gauze, and continue to relax.
The next day, you will remove your dressings and replace it with your postoperative compression garment. Our general recommendation is to wear this garment 24 hours a day, 7 days a week, for 3-4 weeks. Of course, you can remove the garment as necessary for work, special activities, showering, washing the garment, and so on. After the first 4 weeks, you only need to wear it at night for an additional 4 weeks.
Part of our Ideal Liposuction process is treatment with either radiofrequency, or acoustic therapy to help tighten your neck skin, reduce swelling, and maximize your fat reduction. This will be discussed with you before and after your procedure.
You will see immediate results after your treatment, but your results will continue to improve for up to a year. While there are no guarantees, we do offer a unique revision policy that is unique in the aesthetic surgery field.
One of the less-frequently used advantages of chin liposuction, is to use the suctioned fat to actually augment, or increase the size and definition of the jawline and mandible. This was initially popularized by plastic surgeons in Brazil in 2014, although the technique has been around for decades. The issue is hand is that the youthful neck is not only comprised of an absence of misplaced fat, atrophied muscle, and loose skin. There is another component – the age-related absorption of bone – that contributes to the appearance of the aging neck. There are a number of techniques available to improve the appearance of the mandible, including placement of implants, advancement of the bones themselves, and use of injectable products to enhance the mandible. However, your own fat can also be used to strategically enhance the appearance of your jawline, at the same time that the fat is removed from the neck and jowls. In the initial study, all 42 patients showed an increase in the front – to – back projection and total volume at 4 weeks and 6 months after surgery. The front – to – back projection increased from 4 mm to 12 mm (average, 8.9 mm) and from 3 mm to 11 mm (average, 7 mm) after 4 weeks and 6 months, respectively. The total volume increase ranged from 3 to 11 ml (average, 8 ml) after 4 weeks and from 3 to 8 ml (average, 7.4 ml) after 6 months.
What other treatments are available?
Fortunately, we have many techniques available to give a patient a more youthful appearing neck. These include:
- Thread lifting
- FaceTite/ Accutite
- Surgical neck lift (e.g., platysmaplasty)
- Skin resurfacing lasers (e.g., Fraxel, C02)
- Microneedling RF (e.g., Fractora)
- Neurotoxins (e.g., Botox)
- Fillers like belotero, restylane, juvederm, or others to improve lines and folds
- J Plasma / Renuvion for internal skin tightening
- Ultherapy for external skin tightening
- Maintenance therapy (e.g., Pelleve, Venus, Forma)
Given the plethora of techniques available, the most important first step is to see an expert for a full evaluation and treatment plan based on your individual situation and goals.