A prominent Adam’s apple or thyroid cartilage disrupts the profile of the neck and is the one sure sign of being male. It is reduced by a procedure that truly reflects how it is done…the tracheal shave. The prominent union of the two halves of the thyroid cartilage is shaved down through either a direct skin incision over it or from a more ‘hidden’ skin incision up under the chin. In younger patients the cartilage is soft and is readily modified by a scalpel blade in a shaving technique. In older patients, however, the thyroid cartilage will be more firm or calcified and a burring technique may be needed to achieve an adequate reduction of its prominence. While a tracheal shave is the ‘simplest’ of all FFS procedures it also incredibly effective in making the neck look more feminine without a visible bump, or a greatly reduced bump, as seen in profile.
An improved shape of the neck, due to excess fat can be achieved with small cannula liposuction. By reducing the subcutaneous layer of fat thickness between the skin and the platysma muscle, the overlying skin contracts down (upward) to show a more obvious cervicomental angle. This classic neck reshaping procedure is a good complement to chin and jawline changes.
In some patients subcutaneous fat removal alone does not produce the ideal central cervicomental angle show. Fat removal below the platysma muscle centrally and tightening the two sides of the platysma muscle across it produces a more evident cervicomental angle as the neck is pulled up and back. This more complete central neck reshaping procedure is known as a submentoplasty or ‘neck liposuction plus’.
In older FFS patients there may be laxity of the soft tissue along the jawline as well as in the neck. While a lower facelift may not be considered a classic FFS procedure, many older patients benefit by this jawline-neck reshaping procedure. It is both a rejuvenative and feminizing procedure with an improved sweep up along the jawline up into the ear area. Like all facelift surgery there are different magnitudes or levels of the surgery based on the severity of neck sagging and jowling. They can fundamentally be divided into level 1 (mini facelift with no neck work), level 2 (facelift with limited neck work (liposuction) and level 3. (full facelift with submentoplasty neck work) The extent of the facelift surgery is correlated with the magnitude of the aging process.
Dr. Barry Eppley