How is neck liposuction performed?

Before neck liposuction, a topographic map of the fat of the neck and jowls, and even the cheeks, will be drawn with marker in the preop area. Liposuction of this area can be performed either under local anesthesia with intravenous sedation or under general anesthesia. I have performed this procedure under local anesthesia without sedation on patients whom I have already operated on, who I know will not move or talk during the procedure.

Once in the operating room, your face will be painted with an antibacterial Betadine solution and sterile drapes will be used. The surgeon numbs up the 4-millimeter locations of the incisions, in the crease just under the chin and under each earlobe. Through these incisions, a solution of saline and lidocaine anesthetic with epinephrine is infused.

The epinephrine is crucial, as it significantly reduces bleeding during and after the procedure. Of course, if your procedure is performed under general anesthesia, lidocaine is unnecessary. The surgeon uses different-sized tubes, called cannulae, to break up and then suction out your fat.

The tubes are usually 2-3 millimeters in diameter and have several holes, through which fat is sucked. A liposuction machine, really a fancy and expensive vacuum cleaner, removes the fat. More than one incision is used to lessen the chance of a rippled result.

Incisions under the ears lower the chance of crushing an important nerve that lives at the angle of the jaw, which would cause a droopy smile. In the neck, anywhere from 15 to 150 millimeters (0.5 to 6 ounces) of fat is removed. The surgeon leaves just enough to allow the skin to slide over the muscle without sticking to it.

The concept is aggressive removal of the fat, although some surgeons believe that the neck looks more natural with some fat left behind. Usually, one stitch under the chin is all that is needed. The ear wounds heal better without any stitches.

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