Ask Dr. Barber

Q. I am a 46-year-old healthy woman who has inherited from my father a neck that has no definition and seems to be full of fat. On a picture of my profile it is hard to tell where my face ends and my neck begins. I have had this neck for about 15 years, but it has gotten worse since I had children and gained some weight. Is there anything that can be done to restore some definition to my neck?

A. Developing skin laxity in the neck and slowly accumulating some fat in the neck is not unusual as we age. When these changes occur, there is a loss of the tight angularity of the neck that is characteristic of the youthful neck. What you are describing is more of a hereditary condition where there is too much fullness of the neck at an earlier age. This exaggerated amount of excess skin and fat blurs the transition from the lower face to the upper neck. Essentially, the jawline is not clearly visible as a landmark separating the face from the neck. In the youthful neck, the undersurface of the chin should be tight and flat and there is a relatively sharp angle at the junction of the chin to the front of the neck. In someone who has too much fat and excess skin, there is an obtuse angle on profile, so it looks like there is a straight line from the front of the chin to the bottom of the neck. If, when you pinch the neck skin it feels thick or full, you likely have excess fat that is obscuring the angularity.  So, what to do?
There are two options. The first option is to perform liposuction under the chin and the sides of the neck without tightening the skin. In this option, you are depending on the elasticity of the neck skin to tighten itself after the fat has been removed. This skin tightening is more likely to be successful in younger patients, say less than 40 years old. Forty is not a hard cutoff age to perform liposuction alone, it all depends on the quality of the skin of the neck. There is a chance that the neck skin will not tighten to your satisfaction and there can be some residual skin laxity in the neck after liposuction. The second option is to perform the liposuction and perform a simultaneous neck lift. This procedure is best for women (or men) over 40 who may lack the necessary elastic skin. The determining factor for which procedure is best for you is based on your age and the quality of your skin, and can be best determined by a board certified plastic surgeon. One thing to keep in mind after this procedure, either liposuction alone or with a neck lift, is that you must wear an elastic compression garment around your chin and neck for three weeks after the procedure in order to firmly hold the skin against the muscles of the neck to minimize residual laxity.

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