The lower face including the area around the mouth, the lower jaw line, and the neck is an extremely important aesthetic unit. It is hard to find a model that doesn’t have a striking jaw line draped by smooth and taut skin. There is nothing more detracting from beauty than the so-called “double chin”. While most people think that the fullness that accumulates beneath the chin is fat, it is usually a combination of skin, fat and loose muscle. Nothing predisposes to premature aging of this area more than a small chin that does not provide the bone support that highlights the youthful lower face and neck.
While we as humans are programmed to want the simplest approach to solving problems, this can lead to unfortunate results in facial rejuvenation. Each patient should be evaluated thoroughly and individually for optimal selection of rejuvenation procedures. While there should be dozens of points of analysis, I will outline the four major areas of concern below.
Submental fat
There are a few patients, mostly in the younger age groups who have isolated pockets of fat that will respond to liposuction alone. The person should not have muscle laxity or skin laxity to fit into this category. Liposuction of the neck should be conservative to avoid a hollowing look or streaking that can occur with aggressive liposuction.
Muscle looseness
There are two sheets of muscle (one on each side) that support the neck, the platysma muscles. These muscle tend to stretch and sag with time and gravity. They frequently produce unattractive bands in the center of the neck that look like loose skin, but movement with contraction prove that they are the central edges of the loosened platysma muscle. A procedure called a platysmaplasty, done through a small submental (under the chin) incision can tighten these muscles and significantly enhance the youthfulness of the neck in the right patient. This patient should have looseness of the muscles with fairly good skin elasticity. This procedure can easily be combined with liposuction or direct removal of excess fatty tissue.
Skin laxity
A minimal amount of skin looseness can sometimes be improved with the above procedures, but anything more than this requires surgical tightening. The way to tighten the neck skin with the most natural result and least visible scarring is through a lower face and neck lift where incisions are placed in the crease around and behind the ear. Like in facial rejuvenation, the only way to get a natural and long lasting result is to tighten the muscles as the central support of the skin, so therefore, platysmaplasty (or surgical tightening of the neck muscles) should always be a part of a neck lift.
Deficient bony support
Microgenia (small chin). Please visit the
cosmetic procedure section on
chin surgery. Lack of adequate bony support is one of the worst factors predisposing to premature aging, whether it be from a weak chin, weak cheekbones, or weak bone support under the eyes (negative vector). While the majority of surgeons will either recommend a chin implant or ignore this area, Dr. Hobar prefers a
genioplasty.
A genioplasty is a short surgical procedure done through an icision inside the mouth that repositions the bone of the chin. It avoids the need for a silicone implant and precisely allows optimal positioning of the bone in both the vertical and horizontal directions. The surgery is very safe and perhaps the most important benefit of this procedure is that it tightens the supporting muscles of the neck that are attached to the bone (not achieved with chin implant). Please visit the before and after photo section on chin surgery to see the dramatic results that can be achieved with genioplasty for a youthful enhancement of the neck and jawline.
