Fixing the Dreaded Double Chin
The term “double chin” is a misnomer. A double chin is actually a neck problem, not a chin issue. It is due to excess fat in the area of the neck that is immediately below the chin, hence creating the appearance of an extra chin or double chin.
When this problem occurs, it does so to varying degrees, with the worst cases (as noted) looking like double chins. In less severe cases, the under-side of the chin may just look plump without being a double chin. Regardless of severity, extra neck fat is the cause. Because fat is the cause, liposuction is the most sought-after treatment for it…but beware, because in some circumstances, lipo alone can cause problems.
In order to understand whether neck lipo is for you, you must first understand a few things, including how loose neck skin plays an important role.
Extra Neck Fat
As odd as it may seem, not all neck fat is extra. It is important, in fact critical, to have a certain amount of neck fat to provide a cushion between your skin and neck muscles. Without it, your neck would look unnatural. However, extra neck fat is considered by most to be undesirable. Extra neck fat may be hereditary, and if so is usually evident in early adulthood. It may also be acquired, in which case, it is progressive with weight gain. There are also those who have extra neck fat in response to aging, even in the absence of weight gain. In these cases, fat can accumulate in the neck due to a redistribution of subcutaneous fat that occurs with aging.
Regardless of its cause, extra neck fat can cause a person to look heavier as well as older. In fact, it is surprising how neck lipo can make someone with extra neck fat look significantly younger.
Loose vs. Hanging Neck Skin
Loose neck skin is simply skin in excess of what you need to cover your neck. It is most often acquired through aging, weight loss, or both. Rarely does a person under 40 who has not gone through significant weight gain and loss have significantly loose neck skin.
Hanging neck skin involves neck skin that is so loose that it appears to hang off of the person’s neck. In other words, it not only feels loose, but it appears to hang.
Candidates for Neck Lipo
Neck lipo is best suited to people who have extra neck fat and either 1) neck skin which is not loose or 2) neck skin which is loose but not hanging. If you have neck skin which is loose AND hanging, then neck lipo poses an increased risk of skin irregularities. Although neck lipo may still be attempted, there is a reasonable risk that a facelift may be needed to either tighten up the remaining loose skin or remedy irregular skin which developed as a predictable result of neck liposuction on loose hanging skin.
The reason neck lipo may be considered in those who have loose but not hanging skin is because the procedure itself promotes some tightening of the neck skin. This occurs for two reasons: 1) the healing response to liposuction (or any event which requires healing) promotes some tightening of the skin, and 2) with neck fat removed, the neck skin tends to re-drape along the contour of the underlying structures of the neck, such as the muscles, cartilages and bones. As following the contour of these structures necessarily involves a greater surface area for the skin to cover, and being that the skin surface area does not change as a result of the lipo, the skin will necessarily become relatively tighter.
Keep in mind that the degree of skin tightening in response to neck lipo is relatively little. It is enough to justify loose-skinned people having neck lipo, but not enough to justify neck lipo for those with hanging neck skin.
What about Necks with Extra Fat AND Hanging Skin?
Attempting neck lipo in this group is possible, but the results are typically much less favorable and involve a higher risk of irregularities and a greater likelihood that a facelift might be required to tighten the neck skin and smooth any irregularities. So, if both extra neck fat and loose hanging skin are involved, a facelift might be the best option to start with, rather than considering neck lipo. On the other hand, some people are so eager to avoid a facelift that initial neck lipo is an appealing option. This decisions must be carefully discussed with your plastic surgeon.
Jawline and Jowls
Many who have extra neck fat also suffer the problem of having no distinction between the face and neck – in other words, it is hard to tell where the face stops and the neck starts. In these cases, lipo of the neck along the jawline really helps to define this area and can be done at the same time as neck lipo.
Jowls are the pockets of fat along and above the jawline, about halfway between the ears and the chin. Although Jowls are typically reflective of loose facial skin (and hence the need for a facelift), lipo of the jowls can sometimes be performed at the same time as neck lipo. Provided that the jowls are not associated with markedly loose or hanging skin, liposuction of the jowls can sometimes enable a person to defer a facelift for years. Again, this is something best discussed between you and your plastic surgeon.
Neck lipo can be performed as an outpatient procedure in less than an hour. It involves sedation anesthesia. Your plastic surgeon will begin by injecting your neck with tumescent fluid, which is a combination of saline, local anesthetic (similar to novocain), and epinephrine, which helps constrict blood vessels, reduce bleeding, and prevent bruising. Tumescent fluid is not injected until you are temporarily asleep, so that you feel nothing.
Following the procedure, pain is relatively little, and most find that they can return to work in 1-5 days, depending more upon bruising than on discomfort. You will need to wear a compressive garment around your neck and head for several days. Some plastic surgeons may ask you to wear this for a few weeks, but Dr. Loftus has found that 3 days is appropriate for most. You will have 1-3 incisions, each of which typically heal inconspicuously. Again, your greatest limitation with regard to return to work will likely be bruising. Some have no bruising; others may bruise for 1-2 weeks. Most fall somewhere in between with about 3-7 days of bruising. There is no simple way to predict where you will fall.
The cost of lipo of the neck and jawline in the USA ranges from $2000 to $4000, including facility fees, surgeon fees, and anesthesia fees.
Risks of neck lipo are not unlike those of body lipo. They include bleeding, infection, dimpling, irregularities, asymmetry (unevenness between sides), fluid collections (seromas), and need for additional surgery. Because the nerve that controls the lower corner of your lip runs through the area of your neck involved with neck lipo, there is a risk that this nerve could become paralyzed or weakened, resulting in an uneven smile and possibly even drooling. Fortunately, this is rare and the risk can be further reduced by using blunt (rather than sharp) liposuction cannulas (rods).
. If you have loose neck skin, ask your surgeon how much improvement can be achieved with lipo alone or whether you will need a lift (facelift).
. If you have hanging neck skin, try to get comfortable with the fact that you will probably fare better with a facelift than with lipo.
. Ask your plastic surgeon to use small (2 mm) cannulas (rods) to reduce the risk of irregularities and fluid collections.
. Ask your plastic surgeon to use blunt (rather than sharp) cannulas (rods) to reduce the risk of nerve injury to the branches of the facial nerve.