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Consider custom solutions for a sagging neckline

neck-blog

Consider custom solutions for a sagging neckline

Necklines for both men and women can be a focal point of self-consciousness. However, the etiology of an unattractive neckline can be diverse, so treatment options must be tailored to the underlying cause. There is no one solution for everybody. Careful three-dimensional analysis of the soft tissue and underlying bony structure of the midface, lower jaw and neck are imperative to choosing the correct modality to improve your neckline.

Some common underlying causes of poor aesthetic necklines:

Small lower jaw – If you have a deep underbite despite orthodontics and a short chin, this leads to less bone support of the soft tissues of the jawline and submental region. People with this type of lower jaw may have a very obtuse chin-neck angle leading to redundant skin. An ideal treatment for this situation is bony chin advancement (genioplasty).
If your chin is horizontally too short, then an augmentation with a chin implant is an excellent choice. I prefer the Medpore implant, which is carvable, and screw fixated and becomes an extension of the bone.

Both genioplasty and chin implants can easily incorporate the technique of liposuction as a means of sculpting the soft tissues of the neckline by removing unwanted fat. Liposuction induces collagen production and facilities skin shrinkage and redistribution yielding a pleasing result. This combination therapy can produce a wonderful outcome that makes you look more facially balanced. However, if your skin is too loose and hanging, a more formal neck lift may be preferable to liposuction.

Mid face descent of soft tissues – Aging can affect facial fat compartments leading to decreased volume, which results in the midface falling over time. This sagging increases nasolabial folds and causes lower facial soft tissue to drape over the jawline. A crisper jawline can be restored by replacing missing soft tissue volume in the fat compartments of the midface with filler agents like Voluma and Sculptra or via fat grafting. Subtle volume enhancements can create a nice effect on the jawline without looking like you’ve undergone a surgical procedure.

Gravitational changes to the soft tissue of the neck – Gravity affects all of us. The skin and muscles of the anterior neck begin to pull away over time. The appearance of the platysma muscle medial bellies becomes apparent leading to unsightly banding. In the early stages of gravity-induced changes, treatments such as chemical peels, micro-needling and radio frequency can yield improvements and delay the inevitable soft-tissue sagging.
Ultimately the best treatment option is a face/neck lift. A well performed facelift by an experienced board-certified plastic surgeon will yield excellent results with longevity of up to ten years depending on how well you age forward and take care of your skin, avoiding further sun damage.

Obesity: People with elevated body mass indices will accumulate increased fat throughout the body. The neck is no exception. Very mild amounts of fat excess with firm, good quality skin may realize improved contours with Kithera (an injectable product that dissolves fat in the neck). However, in my experience, few patients I evaluate are ideal candidates for this treatment. The injection results in inflammation, which can cause collagen production and skin remodeling, but most people need bigger guns to fight the battle. The price of several rounds of injections is as much as a true liposuction with less effective results.

If you have significant fat in the submental region and reasonable skin quality, liposuction can be a great treatment option to uncover a more normal neckline without a lot of expense or downtime. However, a face/neck lift with a corset platysmaplasty is the tried and true corrective option that works very predictably.

If you’re obese and undergo bariatric surgery or make lifestyle changes to produce massive weight loss, you’ll likely develop excess deflated skin that hangs off your face and neck creating an aesthetic deformity. Modifications of standard face and neck lifts must be incorporated to achieve a pleasing result.

The takeaway is that if you’re unhappy with your jaw and neckline, you can improve your appearance and boost your self-confidence by seeking out proper consultation with an experienced plastic surgeon. During the consult, a detailed facial analysis should be performed. Treatment options can be formulated to yield the best results by addressing your unique issues as presented during the interview. No need to hide your neck behind scarves and turtlenecks any longer.

Common Questions patients have about post-bariatric body lift procedures

1. Will a lower body lift fix all my problems that concern me after massive weight loss?
The surgery of the lower body lift is a constellation of several procedures rolled into a single anesthesia event. It amalgamates an abdominoplasty with a lateral thigh lift, a lower flank-plasty, and buttock augmentation with the patient’s tissue derived from the flanks to give a shapelier appearance that is not flat and amorphous. Many people who have experienced the loss of over one hundred pounds have many areas troubling to the patient beyond the mid and lower torso. These individuals have redundant hanging skin of the arms and medial thighs, significant aesthetic deformities of the breast, and often premature aging of the neck and face. These above mentioned areas are addressed with additional procedures performed separately such as a breast lift with or without a brachioplasty (arm lift), medial thigh lifts, and face- neck lifts. Patients also typically inquire about the order of the procedures and I often state I prefer to perform the lower body lift first to establish the “Keystone “ area of the torso and then I can better make aesthetic judgements about the breasts and thighs with respect to the shapelier proportion of the new torso.

2. Will I spend the night in the hospital after the lower body lift?
Although the lower body lift with all its components takes about 7.5 hours of anesthesia time, The Lucas Center of Plastic Surgery’s protocol is for an outpatient surgery status. People seem amazed at this concept. My explanation is a hospital is for sick patients who require monitoring of unstable vital signs, severe pain requiring IV pain management, the inability to take oral consumption of fluids and nutrients, or the requirement of IV antibiotics. After this very significant surgery we have done very thorough evaluation of what is required to make a patient comfortable, safe and recover in an expedited manner. First of all the surgery utilizes a technique supplemented with tumescent anesthesia which provides local anesthesia with a blood vessel constrictor (epinephrine) which results in a very limited amount of blood loss eliminating any risk of unstable vital signs postoperatively. We also ensure adequate pain management with the combination of a long acting local anesthesia pump to control pain along with narcotic analgesia. There are no limitations on what you can or can’t eat afterwards. At home pain medications can be dispensed as needed, as compared to a busy hospital when your pain control may be limited by the availability of the nursing staff. Home limits the risk of hospital acquired infections which can occur on the nursing floors. Lastly one of the biggest safety measures is the prevention of deep venous thrombosis and pulmonary emboli. Early ambulation even the night of surgery is one of the most important factors along with chemo-prophylaxsiswith Lovenox which can be easily administered at home. In the hospital ambulation is once again limited by the nursing staff availability and can result in almost no mobilization the night of surgery or beyond. In conclusion home is the best place to be after this operation.

3. What are the things patients will be responsible for after surgery?
A patient will wake up in a compression garment that helps to limit swelling and support the abdomen. Four drains will be placed during surgery to reduce fluid collections on the abdomen, flanks and lateral thighs. This will require some care to encourage fluid drainage and the patient or the care giver must measure the output to determine when the drains can be removed. All incisions are closed deeply with resorb able sutures with a layer of a glue –like substance over top so no incisional care is required for two weeks. The patient may shower the first post-operative day. The most comfortable position to rest is in a reclined position to reduce the tension on the abdominal closure.

4. When can I resume normal activities and exercise?
This is a very significant operation which can result in a whole new lease on life by liberating the patient of the imprisonment of the excess hanging skin of the torso. However this comes at a cost of being quite sore and requires subsistence living for about two weeks. After this time many of the inflammatory chemical released by the body as a result of surgical trauma have cleared and most people begin to feel significantly better and are able to resume a more normal life. To feel completely normal it takes around six weeks which is also the time frame to return to regular exercise.

5. What are lifestyle loans? Can they be utilized to finance these procedures?
Lifestyle loans are now becoming more popular and several institutions such as Credit Unions and banks in Knoxville, Tennessee offer loans for cosmetic surgery procedures up to $10,000 with rates as low as 9.20% APR for up to forty eight months. This is substantially more attractive than other popular finance plans to help finance larger procedures such as body contouring after bariatric surgery. Please contact your local bank or credit union for more details.

Liberate your body and spirit with a total body lift after weight loss

Body contouring
As a plastic surgeon, I see patients who have lost amazing amounts of weight through bariatric surgery and have used this to champion new lifestyles which can eliminate diabetes, hypertension and sleep apnea. Often these patients can discontinue all medications previously taken under a physician’s care. Unfortunately, post-bariatric surgery patients, who are otherwise healthy and active, find themselves prisoners in their own fortresses of hanging flesh.

People feel better, but they don’t look better because of the excess skin on their faces, arms, breasts, abdomens, flanks, buttocks and thighs. Many bariatric surgeons try to provide surgical rejuvenation procedures themselves, leading to less than desirable outcomes and even unnecessary deaths. Plastic surgeons have additional training and expertise and are uniquely qualified to provide patients with a “get- out-of-jail card” from their excess skin. The important principles of body contouring procedures can only be learned in a plastic and reconstructive surgical residency.

What are the procedures that can help you look and feel better?

A total body lift is usually broken up into three distinct procedures, each one taking 6.5 to 7 hours to perform. These are complex and nuanced procedures that necessitate a tremendous amount of skill to remove and reshape the skin. This operation is a life-changing event, and everyone is universally very happy.

1. Circumferential lower body lift with gluteal augmentation: The first procedure I routinely begin with is the circumferential lower body lift with gluteal augmentation with vascularized flaps from the flank region. Upon completion of this surgery, I can make better aesthetic judgments about the breasts and legs. The lower body lift is actually three separate operations performed at the same time: a tummy tuck and flank-plasty with lateral-thigh repositioning and gluteal augmentation utilizing skin from the muffin top and positioning the tissue into the gluteal region to enhance the buttocks.

Despite the long surgical time and the complex number of procedures performed, I almost always send patients home that night. They actually do much better at home than staying in the hospital. All incisions are closed deeply, so no sutures need to be removed. There are four drains, which stay around a week. We utilize a pain pump with a long acting local anesthetic to block pain response. Everyone gets a blood thinner for five days to prevent clots. It generally takes around two weeks to start feeling better.

2. Upper body lift (bilateral brachioplasty with lateral chest wall reshaping and breast rejuvenation): The next procedure is usually a combined upper arm and lateral chest wall contouring (otherwise known as an extended brachioplasty). This surgery is often blended with a breast lift with or without an implant. The brachioplasty is a one-stage procedure with very few complications, and patients love the results. The breast rejuvenation is almost always a two-stage procedure, because the tissues after weight loss are quite complex. If the residual breast tissue is very thin, it may require an implant to help create shape and volume during the second stage.

3. Medial thigh lift: The final surgery is typically the lateral thigh lift. In most cases, we perform aggressive liposuction in the area of the medial thigh, then resect the loose tissue left after the liposuction. The incision spans from the knee to the groin crease on the inner aspect of the leg. This allows us to transversely tighten the skin in this distribution for a much smoother, firmer look. Patients can resume fairly normal activities in a week. It’s a transformative experience to feel comfortable in shorts, dresses and pants by unburdening yourself of loose, hanging skin.

If you have lost significant weight from bariatric surgery or by other means and are experiencing the difficulties of carrying around excess skin that is adversely affecting your quality of life, please contact me at 865.218.6210 or go online to thelucascenter.com to begin your three dimensional rejuvenation today.

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