Cervico-facial liposuction as the main technique is not shown to all patients. Its successful application depends on the ability of the surgeon to select candidates for liposuction from patients with suitable anatomical and physiological data. Liposuction is not applicable in patients with unrealistic expectations or in patients with excess skin and a small amount of fat.
Intending to perform cervico-facial liposuction, the surgeon must take into account the tone of the skin, as well as the muscular support of the neck, the skeleton configuration and the overall physique of the patient. Kamer and Lefkoff presented an algorithm for evaluating the sub-chin for the selection of an individual surgical approach, taking into account anatomical features. In another work, Conley showed that the position of the hyoid bone in relation to the chin is the most important factor determining the size of the desired cervical-chin angle. Low, anterior position of the hyoid bone creates under liposuction the prerequisites for a less favorable result than its high, posterior arrangement. This approach to the sub-chin zone is a good start, but the key factors are the results of palpation and the surgeon's flair. Ideal candidates for liposuction as the main technique are those who have good skin elasticity and general muscle tone, as well as medium, for their growth, weight. The greatest benefit from surgery to remove local fat deposits are patients in whom these deposits are disproportionate to the rest of the body. Degrees of skin elasticity and muscle tone are usually good indicators of postoperative skin contraction and tension of the connective tissue membrane; so young patients are more suitable for liposuction. Patients with severe obesity should reduce body weight to their minimum limit; and this should happen no later than 6 months before the operation. In general, the skin of women is more elastic, so they are the best candidates for closed liposuction of the face and neck as the main procedure. The skin of women is thinner, less greasy and better cut over a reduced subcutaneous bed. This does not mean that men are not suitable for this procedure, but their expectations should not be excessive. Age changes in the skin of women are also more pronounced, and they develop earlier than in men. Patient selection can be less meticulous when liposuction is used as an ancillary intervention; in these cases, its use improves the result of another operation, especially implantation on the chin or facelift.
Liposuction is not suitable for patients who have deep skin wrinkles, significant lowering of the muscular layer and protruding ribbon of the hypodermic neck muscle. Excess and inelastic skin often after removal of the moderate and large volume of subcutaneous fat deposits is poorly reduced. Of course, there are exceptions, and such patients can also achieve a noticeable result. Although a significant excess of skin can make it difficult to fit properly, a small excess of it is needed to recreate the contour of the newly formed cervical-chin angle. The problem of the strands of the hypodermic neck muscle is not eliminated by liposuction on the neck and can even worsen after resection of fat. In patients with a significant amount of fat in the sub-chin, previously hidden strands of the subcutaneous muscle after liposuction can be exposed. They need to be informed beforehand that, in order to achieve the optimal result, it is required to perform the plication of the subcutaneous muscle of the neck or complete rhytidectomy.
Finally, during the examination, it is necessary to note and discuss with the patient the violations of the relief of the skin surface, the position of the hyoid bone, the projection of the chin. It should be clearly indicated that such changes as pits, pockmarks, depressions, scars, can not be corrected by liposuction. The position of the hyoid bone and the chin protrusion determine the sharpness of the cervical-chin angle, so the patient must be warned about the limitations caused by anatomical features. Ideally, a high-positioned sublingual bone and strong chin allow the creation of an aesthetically pleasing sub-chin angle.
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