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This solution should be allowed to work for at least 30 min before we start with liposuction. We prefer VASER liposuction in other locations, but we do not use it in the face and neck. There is a danger of ther- mal damage to the nerves.
If we do only liposuction, we make three incisions of 2–3 mm in the submental skin crease and directly behind each ear lobe. In this way we move our can- nulas in an almost perpendicular direction to each other, creating a harmonious net of liposuction chan- nels. We start with 3 mm cannulas and end with 1,6 mm cannulas. We never act against resistance and we aim at the skin so as not to damage deeper struc- tures.
Since 1972 we have possessed a very simple and effec- tive method of improving bodily contours through liposuction. The first person to attach a hollow can- nula to a vacuum machine was Ulrich Kesselring in Lausanne in 1972. The blunt tunnelling technique of liquid imbibed and anaesthetized fatty tissue was invented by Yves Gerard Illouz from France. The first cannulas were very robust, 1 cm in diameter. Now we have smaller-diameter cannulas – 5, 4, 3, 2, and even 1.6 mm – which allow us to do fine work with them.
One started to dare doing liposuction in the neck and face area, when it is indicated. This helps us in achieving optimal contours. For the face and neck we use a cooled solution of the following ingredients:
– 250 ml 0.9% NaCl solution – 250 ml aqua destillata – 25 ml 1% lidocaine – 0.5 ml epinephrine – 300 IU hylase
Liposuction in Face and Neck
Dimitrije E. Panfilov
Fig. 60.1. Submental liposuction
475 60 Liposuction in Face and Neck
Fig. 60.2. a Instillation of tumescent solution 2:1 (two parts of fluid to one part of fat expected to be removed). b After 30 min we start with 0.5 bar liposuction of the submental area and c continue from below the ear lobe oblique to the midline of the neck
Fig. 34.3. a “Pinch test” of the right jowl still not liposuctioned. b The left side has been done; we can pinch only 2–3 mm of skin between thumb and index finger
In 1986 Michael Cunningham extensively re- searched female beauty and among the ten most important factors he found the first two to be broad malar bones and narrow cheeks. According to Cun- ningham, this combination would, like a developed female breast, be a sign of sexual maturity and would prevent paedophilic desire. That is why the half pro- file should have this convex–concave line, Bill Little’s
“ogee line”, and is why we nowadays look for “contou- roplasty”.
The other eight factors of female beauty from Cun- ningham’s list are typical for the baby-face phenome- non: broad smile, wide nares, big eyes, high position of eyes, long interocular distance, big pupils, high eyebrows, and small nose.
When we perform facelifts we very often do lipo- suction in the neck area but sometimes also in the cheeks, especially in the lower parts of them to accen- tuate the convex–concave ogee line. Some cases of fa- cial asymmetry are caused by unilateral fat hypertro- phy. Then we do liposuction only on the hypertrophic side.
Fig. 34.4. a Dermographic planning:
black areas to be reduced by liposuc- tion and blue areas for autologous fat transfer, to augment the malar region and to reduce the cheeks. b Red mark- ing for the larynx – caution – not to be damaged. c Liposuction from submen- tal access. Patient d before (square face) and e 1 day after surgery (oval face)
477 60 Liposuction in Face and Neck Fig. 60.5. a Dermographic markings for areas to be liposuctioned. b Four weeks postoperatively with pleasing semicontour
Fig. 60.6. a Asymmetric face with hypertrophic left side. b During facelift surgery we performed liposuction of the left cheek. Patient c before and d 3 weeks later
The neck can sometimes have a huge amount of fat. Supraplatysmal fat can be removed by liposuction.
Subplatysmal fat is better to be removed under visual control.
Sometimes hypertrophic fat is localized in the sub- mandibular region.
Fig. 60.7. a Isolated lipohypertrophy of the neck. b With liposuction we have removed 250 ml fat. c Special garments should be worn for 3 weeks in this area (body garments should be prescribed for 6 weeks)
Fig. 60.8. a Submandibular fat hypertrophy. b The same patient 3 months later
479 60 Liposuction in Face and Neck
Fat hypertrophy can sometimes be localized in the lower part of the neck. As the procedure becomes more precise, we dare operate on patients we would have refused a decade ago.
Liposuction of face can be done isolated or com- bined with other surgeries, most commonly with liposuction in other parts of the body.
Fig. 60.9. a Fat hypertrophy in the lower portion of the neck. b Three months after liposuction with a 1.6 mm cannula. Side look of the same patient c before and d after surgery
Fig. 60.10. a Liposuction of the lower face, neck, and upper arms planned. b Four weeks after surgery
If the surgeon has a fatty double chin himself/her- self and masters the method, he/she can do the lipo- suction in front of a mirror himself/herself. The sur- geon does not go to a colleague to be shaved, and it is the same region, just below the skin.
As all photographs in this part of the book origi- nate from the author one can imagine whose double chin it is in Fig. 60.11.
Bibliography
Please see the general bibliography at the end of this book.
Fig. 60.11. a Surgeon with a double chin. b Four weeks after autoultrasonolipocontouring
