Chin Liposuction

Hi Dr Yang
I am 2 months post op from having chin lipo. Still some swelling there but on one side I have this ropey tunnel like thing. I heard someone describe as it as “when you have gophers and they make tunnels in your yard. What you see is the earth bumped up a little bit and you can see the path that the animal made when it was tunneling under the lawn? So, it is like a slightly raised line”. Is this normal to have at this stage. I am massaging it. Is there anything else I can do to help it along, I hope it is not permanent.
Thanks
Rose

 

Hi RoseAbbey,

I don’t like to perform liposuction under the chin alone, since there is a high likelihood that it will uncover the platysmal muscle bands. If I do perform liposuction alone, it will be in young patients in their 20-30′s. If they are mid 30′s to mid 40′s, I am already worried about uncovering the platysmal muscle bands, which I think is more aging for a person than having a double chin. I read the post from the liposuction forum. Take note that there were no medical experts discussing the problem, and only lay people discussing explanations given to them by their plastic surgeons for their own problem which may not be actual diagnosis of the original poster’s problem.

In the 2009 post regarding stiff bands after chin and neck lipo, nina10 describes:

“i have lately noticed that extending from under my chin to almost the bottom of my neck i have these really stiff and tender vertical bands. it feels as if my neck muscle has shortened or something.”

Nina10 has the right idea that she feels like it is a neck muscle. Her description that the vertical bands start from under her chin to the bottom of her neck is the exact description of where platysmal muscle bands occur. [SCROLL down to see the picture of the centenarian (100 year old person)].

In response to Nina10, Dataggart describes some kind of swollen tunnel which is probably the explanation given to her from her plastic surgeon. Many plastic surgeons and cosmetic surgeons and cosmetic physicians (what’s that?) perform liposuction, throughout the body and neck area, but not all of them specialize in necklifts. Their main procedure for the neck may only be liposuction under the chin, and they may not even offer necklifts or platysmaplasties. Dermatologists, OB/GYN, ophthamologists, oral surgeons, as well as many other specialties have banded together to form a specialty of “Cosmetic surgery” which is different from plastic surgery. If an OB/GYN or dermatologist who only performs liposuction, but is not trained in the complex anatomy of the neck, their only way of treating the neck is through liposuction. If they over-liposuction a neck, and remove all of the fat between the skin and the platysma muscle, this will create problems. Continue reading …

Nina10 initial response to Dataggart was that her explanation makes sense, but it appears that Nina10 had some doubts about whether they are talking about the same thing:

“What you describe as cannula irritation/damage to tissue in the chin and neck makes sense. i hope that’s what I have, and not some permanent deformity I will start massaging and stretching right away. But what do you mean when you describe this as a tunnel. To me it feels more like a long protrusion, that sticks out when I tilt my head back. Are we basically describing the same thing?”

Caption: Figure 19-6 Unmasking of the platysmal bands (A) and masculinization (B) of the thyroid notch after overaggressive submental liposuction. (From Kridel RWH, Pacella BL. Com-plications of liposuction. In Eisele D (ed). Complications of head and neck surgery. St. Louis: Mosby-Year Book, 1992:791-803. With permission.)

Those “tunnels” are not tunnels inside the fat which is raised up like a gopher hole. I prefer to leave a reasonable layer of fat on the skin and contour the shape of the neck by creating a solid foundation using the platysma muscle to create a corset under the chin. This way, the patient can still have a chin-to-neck angle (cervicomental angle) yet have a thin layer of fat on the skin. If you look at young people’s skin, there is fat under the skin, which plumps it up and creates some “firmness” and “elasticity.” If an area of skin is “over”-liposuctioned so there is no fat left on the skin, and the skin is sticking directly to the platysma muscle, then every single muscle band and muscle twitch will show from beneath the skin. Youthful skin has a layer of fat which cushions and hides irregularities, while if you imagine 100 year old people as seen on Smucker’s 100 year old Birthdays hosted by Willard Scott, these centegenarians who are not overweight, tend to have hanging skin and the anatomy of under the skin, muscles, tendons, veins, etc, tend to show right through the skin.

Compare this 100 year old person’s neck to Nina10′s description of vertical bands from under her chin to the bottom of her neck.

Here is an anatomic diagram of the platysma muscles and notice where the muscle attaches on the jaw and on the top of the collarbone (bottom of the neck). Note the platysma muscle fibers are oriented vertically, similar to the liposuction bands in the woman shown above. Also look at the diagram of the hollow liposuction cannula is removing fat between the skin and the platysma muscle. If all of the fat is removed between the skin and the platysma muscle, then the skin will stick directly to the platysma muscle without the benefit of a thin layer of fat, then the fibers of the platysma muscle becomes visible as bands.

Image credit: http://www.lelyillustrator.com/platysma/

On young people, the front edge of the platysma muscle lays flat against the neck. As we age, gain and lose weight, the front edge of the platysma muscle protrudes for some people as they age. With repetitive motion, my guess is that the muscle edge peels away from the under lying structures and the edge attaches to the skin. For people who gain and lose a significant amount of weight, I think the fat under the platysma muscle pushes it away from the underlying anatomic structures and after the person loses the weight, the fat is reduced and the muscle band edge is unfortunately peeled away and hanging. Another subset of people I see that have early platysmal muscle bands or actively moving muscle bands are people who speak a lot, like anchor men and women/newscasters. If you watch them speak, you can see for some of them their muscle bands protrude as they enunciate and flatten out when they stop speaking. You can imagine that over the years, with repetitive motion, the attachments that keep the front edge of the platysma muscle flat eventually break free and they are left with an exposed platysma muscle band. Another possible theory, is that the repetitive motion increases the strength of the platysma muscle (I have encountered platysma muscles which are 5-10x’s thicker than normal platysma muscles) and this shortens the muscle similar to body builders who are very strong but not very flexible, versus dancers who are strong, but stretch their muscles to keep them long and limber.

http://www.liposuctionneck.com/ wrote:

Neck Liposuction, is it for you?
It is true that not everyone is a good candidate for neck liposuction. Since only fat can be removed by a liposuction procedure the outcome of a liposuction treatment will be greatly affected depending upon the condition of the neck muscles.

One prominent neck muscle is known as the platysma and it extends from the lower jawbone all the way to the collarbone of the neck. It is very thin and spread like a blanket. This muscle is fairly tight in younger people. As the patient begins to age noticeable thin bands begin to appear which can give the turkey-gobbler look. As time goes by eventually the muscle become thickened and rope-like. This thickening causes the tent of skin along the neck.

Care needs to be taken in older patients not to remove too much fat, as it could expose the cord like muscles of the platysma. It is nearly always preferable to use a surgeon who is capable of tightening the platysma or of anticipates that platysma issues may arise. There are several special stitching techniques which can usually improve platysma bands with good success.”

Unfortunately, massaging the platysmal muscle bands do not flatten them out. Curlytail just responded regarding her experience with botox of these muscle bands and it hasn’t worked in her case, nor is a good long term solution in my opinion. george-yang-doctor/botox-and-massage-t141565.html

A platysmaplasty is a procedure which sews the middle edge of the platysma muscles together which creates a sling, or corset under the chin. Although it is not anatomically the same as a young person, who should have a natural separation of the platysma muscle, it does create some angles which simulate the shape of a youthful neck. By doing this, a thin layer of fat 1/8″ or 3-5 millimeters of fat can be left on the skin so it can prevent the skin from sticking directly to the platysma muscle and give a more youthful texture to the neck skin.

I hope this made sense to you. I don’t buy the gopher tunnel explanation. I’m imagining a “surgeon” who performs liposuction only, but was not aware of the anatomy of the neck, and used the gopher tunnel explanation to reassure their patient. If anything, the compression garment should “collapse” the tunnel and no “bumped up” ridges should be seen on the surface of the skin.

I still don’t know what is going on in your case. I think your best bet will be to speak to your own surgeon and ask him or her, whether or not they think the raised ridge of skin is platysma muscle fibers or bands showing through the skin. If you can’t get a straight answer, then consider getting a second opinion with a board-certified plastic surgeon or board certified facial plastic surgeon in your area who is experienced in face and necklifts.

Best,

Dr. Yang