Which Is Better – Neck Liposuction or a Jowl Lift?

Q:  Dr. Eppley, I am a 48 year old female and have begun to notice some fat under my chin, some jowling and some neck wrinkles. I have had gotten two plastic surgery consultations with differing opinions. One said I needed liposuction of my neck with a submentoplasty and fat injections to the jowls. The other said I needed neck liposuction with a jowl tuck-up. These choices seem so different that I am confused. Both plastic surgeons are board-certified and respected in the community.I don’t know which one is right. Any advice would be appreciated.

A:  In reality, both are right and these are just two different options for the same facial aging problem. It is clear that you are what I call a ‘tweener’. Your aging issues are not quite enough for a more extensive facelift (neck-jowl lift) but are more than what liposuction alone can ideally improve. In other words, you have a mild amount of excess skin along the jawline and in the upper neck. As these two options are different in technique, they will also produce different results. I think the right answer for you is defined by how much you want to go through for what result. While neither operation is a big procedure, the liposuction/fat injection approach is less invasive but will not tighten the jowl line as much as a limited facelift with liposuction. (jowl lift) It would help to define what bothers you the most, jowling or neck fat. If it is neck fat go with liposuction. If it is jowling, go with the lift.

Dr. Barry Eppley

Indianapolis, Indiana

What Needs To Be Done To My Face To Make It Look Thinner?

Q:  Dr. Eppley, The problem with my face is it’s very skinny when I don’t smile. When I smile I have the biggest fattest face ever! I have these fat pockets around my nose. And instead of a smile I look like I’m sneering. I was in an auto accident and it caused nerve damage to my left lip. I want to fix my smile so its even again and you can see more of my teeth. I also have a brow that I hate and would like to get rid of. I also would like some work done on my chin because I hate the way that looks. And also when I smile I have “jowls” and I’d like to get rid of those and my double chin. My double chin is hereditary and being tall and skinny this looks very strange. I would also like to get a nose job because I have my fathers nose and I think it looks very masculine. Overall what I am trying to achieve is a slimmer face, with more feminine features and a better more applying smile. I don’t feel like my face goes with my personality, and how I feel. Also anything else you see that needs to be done please let me know.

A:  Thank you for sending your pictures. In looking at your face and reading your objectives I would consider the following procedures. A rhinoplasty is needed to make your nose thinner and less wide, particularly in the tip. I would also recommend buccal (cheek) fat pad removal (subtotal) and small cannula liposuction of the fullness above the nasolabial (lip-cheek) grooves. A lip lift (vermilion advancement) done with differential skin removal (left greater than the right) will help with better lip symmetry and overall fullness. A submental chin reduction is needed to decrease the amount of chin prominence and protrusion. Liposuction can be done in the neck and jowls to remove fat in these areas.

Unfortunately, I can only do limited computer imaging because your pictures are inadequate.  Smiling photos make a lot of facial feature distortion.

You mentioned a dislike for your brows but I am uncertain what specifically you do not like about them. Until I know more, I can not make any recommendations on whether they can or cannot be favorably changed.

Dr. Barry Eppley

Indianapolis, Indiana

Can My Neck Get Fat Again After It Has Had Liposuction?

Q: I had liposuction done on my neck  when I weighted 185 lbs with about 15% to 16% body fat. I had a good immediate change in the shape of my neck from that procedure. I am now 170 lbs and about 12% to 13% body fat. The great results from the liposuction have persisted as I would have suspected. What I am wondering is what will happen if I gain weight back to where I originally was around 185 lbs. I am not planning to but I am curious as you never know what the future holds. Does it matter if my weight fluctuates  between 170lbs and 185lbs? Will the fat return in my neck if I gain weight back?

A: The long-term results of liposuction on most areas of the body are highly dependent on the stability of one’s weight. The neck may be a slightly more privileged site (resist fat re-accumulation) than the stomach or flanks for example, but fat can definitely return there if one gains enough weight back. I think as long as you stay under your weight at the time of your original surgery, then your neck liposuction result should be unchanged. The percent body fat and weight ranges that you are talking about are not significantly large (170 to 185 lbs) so that change will likely not make much if any difference in the neck. However, it behooves you to keep the weight off as the amount of fat that was originally in your neck was there for a reason…so don’t give it a second chance to come back to an area that it once enjoyed.

Dr. Barry Eppley

Indianapolis Indiana

Will Neck Liposuction Improve Sleep Apnea?

Q: I have sleep apnea and a very thick fat neck. I was wondering if liposuction of the neck would help my sleep apnea? My thought is that if the fat was removed from my neck it would not be so heavy when I laid down. That way it would not push down on my neck and obstruct my throat as much when I was sleeping/ Does this make any sense? What are your thoughts?

A: While liposuction of the neck may help improve the shape and profile of it, I doubt very highly if it would make any improvement in your sleep apnea. Your logic seemingly makes sense but the flaws in it are that fat doesn’t weigh very much, the thyroid cartilage protects the voice box and lower area with a stout shield of protecive armour and the usual sites of anatomic obstruction are usually higher and are closer to the base of the tongue. While I don’t think liposuction of the neck will have any negative effects, it is not an acknowledged procedure in the surgical treatment of sleep apnea. Procedures such as septorhinoplasty and turbinate reductions to open the nasal airway, maxillary and mandibular advancements to open up the entire posterior oropharyngeal airway, shortening of the soft palate (fading in popularity) and bony chin advancement and genioglossus procedures to bring the base of the tongue forward are well recognized sleep apnea operations. Other non-surgical efforts include weight loss and various dental appliances. Before considering any of these options, one should be fully worked up by a sleep apnea specialist to search for the most effective solution.

Dr. Barry Eppley

Indianapolis Indiana

Can Liposuction Make My Face and Neck Look Thinner and More Sculpted?

Q: Dr. Eppley, I am interested in getting my fatter face and neck thinned out if possible. I am sending pictures for your review (frontal and profile) so you can see what I mean. I am interested in a buccal lipectomy procedure and submental lipectomy. I have always thought my face has made me look, in pictures, 30-40 lbs heavier than I actually am. I have also looked at people that are obese or considerably heavier than I am in pictures, comparatively, and noticed that my face make me looks extremely heavy which I am not. I would like to have the procedures done if the changes are significant. I would also like to know if the procedures can be done under local anesthesia. Please advise.

A: Thank you for sending the pictures. I can see your concerns with the fuller tissues around the jawline and into the neck. Certainly fat reduction by neck liposuction and buccal lipectomy is all that is appropriate or should be done. The good question is how much improvement will be seen. That is a tough one to answer as the final result is determined by how well the skin adapts and shrinks down. The limiting factor in your result, and in other male patients who look just like you, would be controlled by the subplatysmal fat at the cervicomental angle (it is not all just above the platysma in the neck angle area) and the subcutaneous fat layer around the jaw angle and over the parotid. Subplatysmal neck fat can be removed by direct excision but the jaw angle fullness is more limited because it can not be treated neither by liposuction or direct excision because of the marginal mandibular branch of the facial nerve. While changes will clearly be seen, I would use the term moderate improvement rather than a dramatic change. Because of the variabiity of the result, you should only undergo the procedure if you can accept modest to moderate improvement. If it turns out to be significant or dramatic in your view then that would be a bonus.

To get the best result possible, doing the liposuction and lipectomy procedure under local anesthesia would not be my approach. That limits how much can be done as patient comfort then takes precedence over the extent of the result.

Dr. Barry Eppley

Indianapolis Indiana

Would A Vertical Chin Reduction Have Helped My Neck Liposuction Result Look Better?

Q:  Hello Dr Eppley,  I’m just writing to thank you for the great information you have posted on vertical chin reduction. I’ve always had a long chin and had liposuction on my neck 3 years ago. Afterwards it made my chin longer. I don’t know if it just looks that way or something was done to actually make my chin longer if that makes sense. In any event I’m too afraid to do anything about it, but thank you so very much for providing the great information on your site.

A: The neck liposuction did its job by making the neck less full and improving the neck-chin (cervicomental) angle. But having a long chin to start with by your admission, the improved neck shape has unmasked the chin area and made it look longer. That is actually an optical illusion. But an illusion that aesthetically does not work in your favor. When considering neck changes, it is always important to not overlook the chin area as the two work together to contribute significantly to one’s facial profile. Doing computer imaging would have revealed what neck liposuction alone would look like. It likely would have shown that vertical chin reduction was just as important to an improved facial profile as was the neck fat removal.

Dr. Barry Eppley

Indianapolis Indiana

Will A Chin Implant And Neck Liposuction Improve My Facial Profile?

Q:  Hi Dr. Eppley.  I have seen four different plastic surgeons seeking improvement in my facial profile and, so far, nobody can show me or even tell me that by doing “this” or “that” I would get the end result I’m looking for.  I’m so scared to have the wrong procedure(s) done, or to chose the wrong size of chin implant, you can’t imagine. I have attached some pictures of myself so you can see my chin and neck problem. After reviewing them s there a way we could communicate by phone?  I really need to ask you some questions. I would like to thank you for doing this for me. You are my last hope!!! Please reply, thank you.

A: Quite frankly, I am not sure what the mystery is when it comes to making the facial improvements that you want. Yours is a very straightforward and common problem that I see all the time. It is the classic ‘ying and yang’ problem. The chin must come forward and the neck angle must go back. And how to do that is similarly not  a mystery. The chin implant should bring the chin no further forward in a woman than a vertical line dropped down from the edge of the lower lip. In the frontal view, it must be a tapered chin implant so as the chin comes forward it remains with a more feminine shape and not becomes more square or too masculine. From the neck standpoint, liposuction is certainly needed. The only unknown, and I can not tell this from photographs or computer imaging, is what the neck and jowl skin will do. Is it good enough quality skin to tighten up on its own or does it need a little help via a jowl-neck tuck-up from incisions around the ears?

I have attached some predictive computer imaging so you can have an approximation of what the outcome from a combined chin implant and neck liposuction and recontouring procedure would be. It is unfortunate that after four plastic surgery consults, this ‘mystery’ has not become unveiled to you.

I am happy to talk to you by phone or Skype any time. Just let me know your availability and we can work out a time.

Dr. Barry Eppley

Indianapolis Indiana

What Can Be Done To Get Rid Of My Double Chin?

Q: I am 5’7″ and weigh 128 lbs. Even though I am relatively thin, I have always had a double chin for some reason. But I feel like it has gotten worse since I have given birth to two children and have gained over 40 lbs with each pregnancy.  I am interested in knowing what could be done and how much improvement I could expect. Getting rid of this double chin would help me feel more confident. Thank you so much for your time.

A: The cause of a  ‘double chin’ is a combination of three anatomic factors; neck fat, neck skin, and chin projection/prominence. Every double chin is made up of differing ratios of all three components. It is always about how much neck fat is there, how much extra neck skin there is, and how short one’s chin may be. While you didn’t state your age, that number also has an influence because it suggests how much neck skin you may have and, most importantly, how elastic it is.

Some double chins can be corrected by as simple a procedure as neck liposuction in someone who is young and with decent chin projection. On the flip side, an ‘older’ severe double chin may require everything including neck liposuction, chin augmentation, and some form of a necklift to help tighten the extra loose skin. Each patient must be assessed individually and a custom treatment plan devised as double chin correction is not a one size fits all procedure.

One surprising aspect to the ideal correction of double chin problems is that of the chin. Many people have short chins that are magnified by this problem. Lengthening the jawline with a chin implant while bringing the angle of the neck back (or making it more defined) is the classic ‘ying and yang’ approach which together makes a better result than either change alone.

Dr. Barry Eppley

Indianapolis Indiana

How Can I Get Rid Of My Double Chin?

Q:Dr. Eppley, Can you tell me how to get rid of my pesky double chin? It bothers me tremendously. I am only 43 years old and my neck looks twenty years older! I am too young to look like this. I am at a good weight and haven’t been able to shake these two chins off no matter what I do. What do you recommend?

A: The ‘double chin’ appearance comes from two upside down hump areas. The first is the chin, which everyone has, but in the double chin patient it is often short or set back. This can make it appear that it is part of the neck when it should be a more distinct forward prominence of the jaw. The second hump or sag is the soft tissue of the neck. This may be just a lot of fat but is usually mixed in with some loose skin as well. This is particularly so in older patients who may have overall neck skin laxity. Given your relatively young age, I would envision that the anatomic composition of your double chin is a bony chin shortness and a collection of fat with some mild amount of loose skin in the neck.

Therefore, correction of your jaw and neck contour could be done by a combined chin augmentation and neck liposuction. It may also be beneficial to do a little neck muscle (platysma) tightening at the same time to get the best neck angle. I doubt if you need any removal of skin at your age and we would rely on the natural skin tightening that occurs after liposuction in good quality skin.

Dr. Barry Eppley

Indianapolis, Indiana

How Can I Get Rid Of My Double Chin?

Q: I have an inherited double chin that makes me look twice my 46 years of age. Can you make it disappear so I can look younger ??

A: A  ’disappearing’ act is what we do a lot of in plastic surgery. Whether it be liposuction, chin implant, facelift…or some combination….it certainly can be made to ‘vanish.’ I know that your double chin makes you look older….but I doubt if it makes you look 92!

When patients refer to a ‘double chin’, this means there are at least two and sometimes three rolls of skin if you include the chin as one of the rolls. The double chin is often the result of the combination problem of a full neck and a short chin. In the younger patient, this can be improved by doing chin augmentation and neck liposuction at the same time. When you move two different things in opposite directions, the result becomes greater than when only one is done alone. In an older patient with more loose skin, this diametric action may require chin augmentation and a facelift to get the neck going back and up as the chin comes forward.

If the forward position of the chin is adequate, then the neck alone can be treated. Again, age and the amount of loose skin determines whether liposuction (good skin) or some version of facelift (bad skin) is needed.

Correction of a double chin is highly effective plastic surgery adventure and can make for a dramatic difference in one’s appearance.

Dr. Barry Eppley