Liposuction first arrived in 1985 and very quickly we learned to adapt the techniques to help remove excess fat from the neck. It was done with a tiny incision where the chin meets the upper neck. That’s a perfect place because it is hidden. And we would use a cannula or narrow suction tip to evacuate the fat that sat between the platysma muscle and the skin.
However, we observed that the results were not as good as we wanted them to be. We asked ourselves why this was the case.
The answer came with cadaver dissections and further anatomic studies which convinced us that the key to success was doing more, that liposuction alone was inadequate. We needed to address the sagging of that platysma neck muscle and that even direct ourselves to the next layer of fat below that muscle which would not be accessed by routine liposuction.
When these two additional components were added, the removal of fat beneath the platysma and then actually trimming the redundant or extra edges of the platysma, and then tying them together with sutures to form an internal sling or corset, the results became quite impressive. That is what a neck sculpture procedure is. It is liposuction with two other steps in the operation that allow the best possible definition between the jaw line and the neck.
Understand that this operation – since it removes quite a bit of tissue – relies on the skin’s elasticity to contract to envelope a smaller neck. If the skin is sun damaged, stretched out, very wrinkled, thin and parchment-like, it is predictable that the skin does not have the ability to snap back like a tight rubber band or like a brand new balloon and that the skin, therefore, cannot drape evenly. If the skin cannot drape evenly, the result will not look good. Patients with such skin are not candidates.
In order to assess one’s candidacy for the procedure, it is necessary to evaluate the skin’s quality, particularly its elasticity and redundancy. Typically, men can have the procedure up to the late 60s because men’s skin is thicker and tends to remain more elastic. But few women older than 45 or 50 qualify because typically the women’s skin by that age perhaps due to decline in hormones, is thin, less elastic, no longer that nice tight rubber band and would not be up to the task of contracting evenly and giving a nice smooth skin contour.
