The shape of one’s neck has a profound influence on the appearance of the face that sits above it. The neck is bordered by the jawline, which consists of the chin and the horizontal length of the jaw, and the outline of the neck skin The outline of the neck should be the intersection of horizontal and vertical lines which intersect at an angle point just above the thyroid cartilage. (adam’s apple) A more youthful neck angle is usually in the range of 100 to 120 degrees.
Aging of the face is usually associated with loss of a good neck angle. At fat accumulates in the neck and the skin becomes more loose and saggy, the neck angle changes. In profile, it opens up to a neck angle which can be as big as 180 degrees. When this occurs, there is no neck angle and a straight line runs directly down from the chin to the sternum.
Reshaping of the neck angle, technically known as the cervicomental angle, takes three basic approaches. The approaches often use a combination of neck tissue reduction and tightening and/or chin augmentation. How short the chin is and how much loosed skin there is in the neckdetermines whether a Type I, II, or III neck recontouring is done.
In the type I neck deformity, the neck problem is a moderate collection of fat but there is not an excess of neck skin or it is not overly lax. In addition, the chin projection is adequate. Correction here consists of liposuction alone. In many instances, the liposuction can be done under local anesthesia. I currently prefer the use of Smartlipo because of its potential skin tightening benefits.
In the type II neck deformity, the neck problem is still a moderate amount of submental and neck fat with reasonably tight skin. At the least, the skin has good elasticity and feels like it can tighten up fairly well. The chin, however, is horizontally short. The combination of chin augmentation with an implant and Smartlipo to the neck produces a much sharper neck neck angle.
In the type III neck deformity, all three neck components are deficient. The chin is short, there is a good amount of fat in the neck, and the neck skin is loose and non-elastic. The neck liposuction and chin implant is complemented by a facelift. The facelift tightens all of the neck skin and produces a very well defined neck angle again.
The surgical strategy to improve a poor neck angle must consider the bone (chin), the amount of fat, and the one real key…how much loose skin is there. Unlike the younger neck where the tightening of the neck skin is more likely, this is a missing element in the older neck.
Dr. Barry Eppley
Indianapolis Indiana