4 Steps to Achieve Optimised Neck Liposuction Results

According to Wide-undermining Neck Liposuction: Tips and Tricks for Good Results published on Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery (2014), neck rejuvenation is one of the most sought after procedures in the restoration of the facial contour. The face looks much older when the cervicomental angle becomes less defined, therefore neck contour is a key factor in facial rejuvenation, particularly the submental and submandibular areas. Wide undermining and local anesthesia are key to obtaining good results in selected patients who want a quick recovery.




PROCESS


The neck-aging process involves different components, i.e., skin, fat, muscles, and salivary glands. The correct identification of the anatomical structures involved in this process is fundamental in the choice of the right surgical technique.



During the liposuction procedure, surgeon inserts a small cannula through an incision beneath the chin or behind the ears, removing excess fat and sculpting a contour or the chin and neck.


Undermining is a surgical technique, it means cutting the fibrous septae that connect the skin to the underlying fascia, and generally this is accomplished by using the scalpel to cut the septi just beneath the dermis as shown below.



Undermining has the advantage of freeing the wound edges and decreasing tension on the wound which allows for faster wound healing and lessens the chance of scar spreading and keloid formation. One rule of thumb is that one should undermine about the same radius as the maximum width of the wound.


1. Preoperative Marking


Markings areas: the liposuction area where fat had to be removed & the surrounding area of dissection. Liposuction area varies across different patients and also depends on the amount and the disposition of fat to be removed. On the other hand, the dissection area is similar with most patient, i.e., rhomboid-shaped, wider than the area that for liposuction, and extending from the whole submandibular region to the neck area down to the level of the thyroid cartilage.


To prepare for the surgery, patient will be placed in the supine position, with the head hyperextended & landmarks of the mandibular border identified before local anaesthesia.


2. Local Anaesthesia


The amount of infiltrated solution depended on the neck area that needed to be treated; on average, 45 cc of solution to be prepared. The liposuction area will be infiltrated by the superwet technique using a short Klein needle connected to a 10 cc syringe. While the surrounding area of dissection, infiltrated with a smaller amount of solution that allowed for good anesthesia and hydrodissection.


3. Surgical Technique


Fifteen minutes after infiltration, when adrenaline started having an effect and the skin became bleached, that will be when surgery begins. Gentle and slow manual aspiration to be performed using an in-and-out technique. In the area of lipodystrophy, make several tunnels with the cannula until the amount of fat that needed to be removed was aspirated. Retract the piston of the syringe to the 3-cc marker to create a mild negative pressure, which helps to avoid aggressive damage to the adipocutaneous flap and allows it to be thinned in a harmonious way. The aspiration needs to be under constant visual and manual control, and using a finger test to check for uniform thickness by pinching and rolling the skin. During the procedure the assistant will need to keep the skin wet and also performed the necessary countertraction, especially during detachment.

A very thin layer of fat (a few millimeters) will be left in place beneath the dermis, to avoid subdermal suction and obtain adipocutaneous flap.


At the end of surgery, using the undermining technique a subcutaneous stitch was placed to close the incision after pressing with a roll of sterile dressing to drain the area. The skin was gently distributed by hand with care so that the flap properly adapted to the new profile of the region without any skin distortions in order to avoid any irregularities.


4. Postoperative Period


Early in the postoperative period, patients are instructed to perform a very light lymphatic massage to improve the pain as well, starting at the medial area and moving toward the lateral area.



8 hours after surgery, pain management can be obtained by administration of paracetamol 500 mg, one tablet every 6 hours for the first 2 days. After 15 days, mechanical vacuum lymphatic drainage may be recommended twice a week for 1 month for faster healing. The vacuum is also useful for stimulating the contraction of elastic fibers and facilitating skin retraction. In addition, firming creams might also be recommended to enhance healing and improve results.


In the hands of an experienced surgeon, the procedure is a safe method rendering excellent aesthetic results. But occasionally there may be cases of weakened lower lip function and a crooked smile after neck liposuction because the marginal mandibular nerve was affected or even swollen vocal ligaments. Such nerve edema and inflammation may treated with oral/intraveneous cortisone but perfecting techniques will still be key.


REFERENCE

Wide-undermining Neck Liposuction: Tips and Tricks for Good Results published on Aesth Last Surg (2014) by Alessandro Innocenti • Chiara Andretto Amodeo • Francesco Ciancio

Safety of Liposuction of the Neck Using Tumescent Local Anesthesia: Experience in 320 Cases (2012) by BOENI ROLAND

Dermatology, Procedures - Undermining by John L. Bezzant, (1997)

What to Expect After Neck Liposuction? (2019) by Kristina Zachary Medical Corp

Liposuction of the face and neck VOLUME 18, ISSUE 3, P261-266, SEPTEMBER 01, 2007


 


Learn Liposuction & Fat Transfer under Local Anaesthesia, IV Sedation for Easy Aspiration of the Fat Tissues at our upcoming Mini Fellowship (Hands-On) happening in Seoul:


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Liposuction & Fat Transfer for Face & Body Under Local Anaesthesia


December 15-16, 2022 - Seoul, South Korea - [Register Now]



 


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