Patient selection for liposuction of the face and neck

Cervicofacial liposuction as a primary technique is not indicated for all patients. Its successful use depends on the surgeon's ability to select candidates for liposuction from patients with suitable anatomical and physiological data. Liposuction is not applicable to patients with unrealistic expectations or to patients with excess skin and a small amount of fat.

When considering cervicofacial liposuction, the surgeon must consider the skin tone, as well as the muscular support of the neck, skeletal configuration, and overall body composition of the patient. Kamer and Lefkoff presented an algorithm for assessing the submental area to determine an individual surgical approach based on anatomical considerations. In another study, Conley showed that the position of the hyoid bone relative to the chin is the most important factor in determining the desired cervicofacial angle. A low, anterior hyoid bone position creates a less favorable outcome for liposuction than a high, posterior hyoid bone position. This approach to the submental area is a good start, but palpation and surgeon's instinct are key factors. Ideal candidates for liposuction as a primary technique are individuals with good skin elasticity and overall muscle tone, and an average weight for their height. Patients who benefit most from surgery to remove localized fat deposits are those whose deposits are disproportionate to the rest of the body. Skin elasticity and muscle tone are usually good indicators of postoperative skin contraction and connective tissue tension; therefore, younger patients are better candidates for liposuction. Patients who are severely obese should reduce their body weight to their minimum limit; this should be done no later than 6 months before surgery. In general, women have more elastic skin, making them better candidates for closed liposuction of the face and neck as a primary procedure. Women's skin is thinner, less oily, and contracts better over a reduced subcutaneous bed. This does not mean that men are not suitable for the procedure, but their expectations should not be excessive. Age-related skin changes are also more pronounced in women and develop earlier than in men. Patient selection can be less selective when liposuction is used as an adjunctive procedure; in these cases, its use improves the outcome of another operation, especially chin implantation or facelift.

Patients with deep skin wrinkles, significant drooping of the muscle layer, and protruding bands of the platysma muscle are not suitable for liposuction. Excessive and inelastic skin often does not contract well after the removal of moderate to large amounts of subcutaneous fat. Of course, there are exceptions, and noticeable results can also be achieved in such patients. Although significant excess skin may make it difficult for it to fit properly, a small amount of excess skin is necessary to recreate the contour of the newly formed cervicomental angle. The problem of platysma muscle bands is not eliminated by liposuction of the neck and may even be aggravated by fat resection. In patients with significant amounts of fat in the submental area, previously hidden platysma muscle bands may be exposed after liposuction. They should be informed in advance that platysma muscle plication or total rhytidectomy is required to achieve an optimal result.

Finally, during the examination, it is necessary to note and discuss with the patient any irregularities in the skin surface relief, the position of the hyoid bone, and the protrusion of the chin. It is necessary to clearly indicate that such changes as pits, pockmarks, depressions, and scars cannot be corrected by liposuction. The position of the hyoid bone and the protrusion of the chin determine the sharpness of the cervicomental angle, so the patient should be warned about the limitations caused by anatomical features. Ideally, a high hyoid bone and a strong chin allow the creation of an aesthetically advantageous submental angle.

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