The Tumescent Technique
Sometimes exercise or eating a healthy diet will not prevent some people from having excess fat in the face, specifically in the neck. This area is particularly troubling for many people and can tell the world that you are or were once overweight, even if you have worked hard to change the rest of your body. Fortunately, neck liposuction provides a way to remove that extra fat from below the jawline and in the neck—the so-called “double chin.”
The neck is a rather delicate area and, as such, neck liposuction requires a careful hand and a special technique. Most surgeons have moved to the tumescent technique for neck liposuction because it confers several advantages over traditional neck liposuction methods.
The tumescent technique for neck liposuction involves infusing the area under the jawline with lidocaine, epinephrine, and saline solution such that it expands far beyond its normal size. The lidocaine deadens the nerves endings in the region making the entire neck numb. The epinephrine squeezes blood vessels in the neck so that when they are disturbed by the liposuction probe, the leak very little blood. The saline lifts the skin away from the many delicate or important structures in the neck like the trachea, esophagus, thyroid and parathyroid glands, and the larynx.
There are several advantages of using the tumescent technique for neck liposuction. Perhaps most importantly, this approach is performed under local anesthesia, not general. This means a faster procedure, quicker post-surgical recovery, and lower cost for the patient overall. Also, many patients are not good candidates for general anesthesia because of coexisting health problems. The local anesthesia approach to neck liposuction opens the door to people that would otherwise be turned down.
Because of epinephrine that is infused with the tumescent technique, there is less blood loss during surgery and patients do not need to have intravenous fluids or blood. The blood vessel squeezing of epinephrine means that less lidocaine and liquefied fat are absorbed into the bloodstream—these things can lead to problems if they are present in high concentrations in the blood. The lidocaine that is infused is bacteriostatic, meaning that it helps prevent infection from bacteria. The infused lidocaine may deaden the nerves in the area for up to 24 hours after the procedure. The soreness that immediately follows liposuction can be avoided for up to a day. During that day the body will adjust and begin to heal, and the overall discomfort will be less. Further, oral pain medications will have a chance to fully take effect leading to a much more comfortable recovery.
Beyond these advantages for the patient, the tumescent technique for neck liposuction magnifies the pockets of fat that are to be removed and provides the surgeon with an excellent view of the surgical field. Since the neck is expanded to several times its normal size, the cosmetic surgeon can guide the liposuction cannula to precisely where it is needed. This enhanced visualization of the neck helps to ensure that all of the fat can be removed from the neck in one liposuction procedure.
While most physicians perform the tumescent technique for neck liposuction, you should speak to your surgeon to determine whether neck liposuction using the tumescent approach is right for you.
Neck Liposuction and Beyond
As we age, the elasticity of the skin decreases, and the laxity increases. While younger patients with excess fat in the face may only need closed neck liposuction, older patients may need a bit more. In addition to excess fat in the neck—fat that only partly responds to a healthy diet and exercise—there is also excess skin in the faces of older people. This layered, wrinkled skin gives away a person’s age and often makes people appear older than they really are. What can be done about the excess fat in the neck when it is accompanied by excess skin? The most favorable cosmetic result comes from neck liposuction combined with one or more additional procedures.
When performed with a facelift, neck liposuction can be done open or closed. Closed neck liposuction is what many people think of when they think of liposuction. A small incision is made in the skin and a thin liposuction probe is passed into the layer of fat tissue. The open procedure involves making large incisions into the skin and exposing the fat so that the surgeon can see it directly. The open neck liposuction procedure has advantages and disadvantages. An open neck liposuction procedure permits the plastic surgeon to see all the areas of excess fat and thus remove it directly. Unfortunately, when the skin is open, the vacuum that is normally created during the closed procedure does not exist. This means that the skin is more or less picked off by the neck liposuction probe. Also, since the fat layer is fully exposed, it is difficult for the surgeon to mentally envision what the contour of the neck will look like when the skin is closed. Also, an open-neck liposuction approach does not permit the tumescent technique, a method that confers several advantages.
In addition to increased skin laxity in older individuals, the skin becomes much thinner as well. This means that special care must be taken by the plastic surgeon. She must make very precise incisions and leave just enough skin to provide full flexibility of the neck, but not so much that it drapes unattractively. Finding this delicate balance requires a skilled surgeon. If you are contemplating neck liposuction with an accompanying facelift, you should find a surgeon that has extensive experience in treating older individuals. Ask to see before and after photos; most plastic surgeons are happy to show their work.
In certain cases, neck liposuction plus a facelift does not fully restore the youthful appearance that many seek. In these cases, chin implants may be useful. Once the excess fat and skin have been removed with neck liposuction and rhytidectomy (facelift), a small synthetic implant can be strategically placed in the chin or along the jawline. This creates a stronger jawline and more of a contrast between the line of the face and the line of the neck. While we are often not consciously aware of it, we measure those lines and angles with our eyes and brains almost instantaneously. From that calculation, we make an assessment of a person’s age. For those people that are truly committed to restoring a youthful appearance to the face, neck liposuction and a facelift with chin and jaw implants can make a dramatic difference.