INTRODUCTION
In the arena of facial aging and facial rejuvenation there is nothing so bothersome to patients and so minimally invasive and so dramatic results as facial liposuction and associated procedures. Regardless of your age, this is most often seen as involving fat accumulation and lack of definition in the neck and under the chin and along the jawline where patients do not like the look and want improvement. It is the single most often gratifying and predictable and safe and permanent of all the minimally invasive facial rejuvenation procedures that Dr Romano performs.
INDICATIONS
First and foremost, patients notice mostly the superficial fat accumulation under the chin and around the jowls and jawline that is bulging and bulky and above the muscles. See diagram below. This can be present from a very early age and unresponsive to diet and exercise. Most patients describe this as “…I don’t want to look like my father [or parent]” as a testimony to this being a fatty accumulation feature that is genetic and inherited. There can also be fat excess in along and under the jawline or “jowls” as well as in front of the ears or the cheeks. All these areas are very predictably accessed and treated safely by liposuction.
Subtle and related to above is the deep fat that may be in addition to the superficial fat in several areas and largely contributing to the features you do not like in the central neck and midface. This is the fat beneath the facial muscles in two distinct areas. The most often seen is the fat under the chin and platysma muscle called the subplatysmal fat. It can largely contribute to the under chin bulging and lack of definition. The only other area of deep fat is the buccal fat or fat pad of bichet in the midface. This fat pad is very distinct and can be quite large and present as bulging in the midface between the cheekbone and above the jawline. It is often confused with the superficial fat in that region and takes expert evaluation as with Dr. Romano to identify and quantify this fat accumulation.
Second to these features of the fat noted above, patients will next often identify and complain of the “turkey neck” which in fact is not fat but the relaxation and bulging and laxity of the neck muscle called the platysma. It is most often identified as two vertical bulges or bands. (See diagram above). Through the same small incision under the chin, this can also be directly treated and cured at the time of liposuction of the neck.
Thirdly, and importantly, patients may identify some loose skin as it is associated with fat excess and relaxed bulging muscles in the spectrum of facial rejuvenation. The loose skin is often mild in comparison to the fatty accumulations and is in the same area. The good, really great news is that after the fat is removed the skin will contract and mold down around the reduced fatty framework. This means no cutting skin, no facelift, and no incisions. So, in well-chosen and in well-educated patients the skin laxity will improve dramatically as a byproduct of the fat removal.
Lastly, patients may relate the above noted features to a small or “weak” chin. This can be evaluated as a potential to address by a chin implant. This can very safely and predictably be done at the same time through the same small incision under the chin.
The relative anatomy in basically as reference above, the superficial fat, the deep fat, the muscles, the bony foundation, and the skin of the face and neck. The superficial fat, and only the superficial fat wherever located in the body, is the only fat accessible by liposuction. This is the fat just under the skin and above any and all vital structures. There are some nerves and blood vessels in the fat but not many and easily moved aside and avoided by liposuction. This is the fat that you can pinch up in the jawline and jowls and face. The deep fat is distinctly below the muscle layer and can be related to some vital structures, so this is only accessible directly through small incisions and surgical removal. It is through this same small incision below the chin for platysmal fat removal that the midline bulging, and relaxed muscle of the platysma can be trimmed and tightened, a chin implant inserted, and all made smooth in the neck. Finally, the skin, even when pretty loose will always shrink down around the reduced fatty framework. This is the work of the elastic fibers in the skin (that recoil) and the collagen fibers (that shrink and contract).
The surgery is performed as an outpatient under general anesthesia. The surgical plan and the different stages to undertake are understood and agreed in advance. After you are asleep, Dr Romano is expert at injecting a local anesthetic like Novocain, so you are completely numb. In this way, while still asleep, you do not need as much anesthetic from the anesthesiologist. Liposuction is performed first, and this may be all you need depending on your anatomy. This can be performed through very tiny incisions at the earlobes and under the chin. The next stage, if indicated, is to remove the deeper fat if present in the buccal space or sub-platysmal – one or both. This is done through very small incisions. If there is buccal fat a small incision is made inside the mouth and the fat is identified, the amount to remove is determined (not all of it) and excised. Next if there is fat in the neck under the platysma muscles, this is approached through an extremely small and cosmetic 1.5” incision under the chin. Here the muscles are separated and the fat under the platysma muscle is artistically sculptured and some or most removed. Here, at the same time through this incision, the excess platysma muscle bulk or laxity can be treated and a chin implant also put in if any of all of these are required.
Ultimately with all this correction and intervention, you only have a ¼” incision at each earlobe and, at most, a 1.5” incision under the chin. A lot can be done safely and predictably through these incisions.
The recovery is extremely comfortable and quick. You will wake up with an elastic garment on you face you will wear for 2-3 days then not at all. You will have little or no pain and some swelling which is minimal. You will have virtually no black and blue, maybe a little yellow color. You will be presentable in public in 4-5 days. You will resume your activities and even exercise in about 1 week.
Here is the link to the website Facial Liposuction section if you have not already viewed it.
For any questions or to schedule a live or virtual consultation please call or contact the office. You can speak with Dr. Romano personally. info@sfplasticsurgery.org. 415 981 3911
