In neck liposuction, as is the custom, tiny skin entrance wounds are made with a scalpel just under the chin and just in front of the ears. Usually the surgeon will pass (use) a spatula-type cannula that is relatively flat at the tip. A spatula is usually the most desirable type of cannula to use in the neck. A bullet-shaped cannula would tend not to track as easily along the proper plane or path in the neck. In the neck, unlike most of the rest of the body it is best to keep the cannula very close to the underside of the dermal (leather layer) of the skin. The cannula opening may point into the fat layer below or may scrape the dermis above in order to cause tightening. The face and neck are the only parts of the body in which this cannula superficial scraping process may be accomplished with some safety. The platysma is a sheet-like muscle that extends from the lower jawbone all the way to the collarbone of the neck. It is thin and spread like a sheet. The platysma is usually fairly tight in younger people. However, the noticeable thin bands in older women, which also give the turkey-gobbler look, are usually the result of the platysma. Platysma bands eventually become thick and cord-like, which causes them to tent the skin of the neck as they contract, tether or dangle between the jawbone and the collarbone. The combination of platysma and fat is the primary concern if a patient is just to have a neck liposuction without any surgery to improve the platysma. Take, for example, a 40-year-old woman with a lot of fat in the neck, which is covering or hiding what would normally be (if they were thin) bands or cords of platysma. If the fat is sucked away via liposuction alone, unsightly bands of platysma may be left behind especially if they do not respond by self-tightening or dermal tightening related to the liposuction. It is best to have a surgeon who is capable of tightening the platysma or of anticipating platysma problems (if these arise along with the liposuction); several special stitch techniques usually improve platysma bands with good success.
Occasionally, it may be very difficult to detect some platysmal bands, since they are soft, floppy muscles and can be easily hidden in fat. It is much easier to detect a protruding hyoid bone or an outstanding laryngeal cartilage, or Adam’s apple. It is easy to feel the solid, relatively firm muscle of the tongue and sometimes the submandibular glands or salivary glands under the angle of jaw. None of these hard structures, including muscle or bone, can be removed by liposuction; liposuction simply removes fat. If a patient has large tongue muscle or a big hyoid bone, sucking overlying fat away may simply allow those structures to be more easily seen by the public. It is important to consider that before you have neck liposuction that your surgeon should touch and feel the underlying structures of the neck. If the structures of the neck are found to be uniform and are lying deep within a soft fatty layer, then removing that fatty layer should leave none of these structures standing out, none that are prominent or unsightly. Remember that digital photography and imagery can be very unrealistic, especially when we are dealing with body areas that are made of several layers
Liposuction of the neck can have one benefit; in fact, it is desirable for the liposuction of the neck to cause a hidden, sheet-like scarring in the neck. The sheet-like scarring in the neck is brought about by the diffuse trauma (controlled and spread-out damage) caused by the liposuction cannula in the fatty layer. Remember that wherever the liposuction cannula passes, it may suck out and remove some fat, but in its wake it leaves a tunnel, which eventually scars and therefore possibly contracts. The tunnel will collapse back and respond to injury by forming fiber cells, which make up scar tissue. This very desirable net-like arrangement of scar tissue caused by the interconnecting tunnels of the liposuction cannulae will contract and give one a tighter neck. Many times the contraction following neck liposuction is strong enough to prevent the platysma bands from being seen, because the contraction forms a sling of tight neck skin and dermal tissue. Unfortunately, this does not always happen; and generally the younger the patient, the better result of neck liposuction. Still, remembering the structures we just talked about; no matter what your age, if those structures are not proper for the neck liposuction, the final result may leave something to be desired.
Many patients will choose to combine their neck liposuction with additional procedures such as chin implants, neck lifts, and repair of the neck muscles. Neck liposuctions involving multiple procedures can result in more noticeable improvements and longer lasting effects, and neck liposuction surgeons performing multiple procedures in one session may be able to offer reduced rates.