Three minimally-invasive lipo-based neck treatments

There are three minimally-invasive ways of doing liposuction to improve the neck. Those options cover most cosmetic patients-from those who have only a small amount of fat to remove, to others with receding chins and loose skin, according to Rhoda S. Narins, M.D., director of the Dermatology Surgery and Laser Center and clinical professor of dermatology at NYU Medical Center.

Dr. Narins was among the panel members presenting during a session on “Neck Obsession: Comprehensive Neck Rejuvenation” at the 2016 American Society for Dermatologic Surgery (ASDS) annual meeting in New Orleans. Her topic: “Liposuction and Threads.”

Each of the three lipo-based approaches she describes require one treatment, a local anesthetic, and result in little to no swelling, bruising or pain.

This is opposed to other options, such as Kybella (deoxycholic acid, Allergan), according to the dermatologist. Dr. Narins, who was involved in the initial studies for Kybella, says Kybella works very well, but patients need at least two treatments and the treatments often cause pain and swelling.

The big three

The first of the three lipo neck procedures involves injecting tumescent anesthesia and then simply using a 10cc syringe and extractor and sucking out the fat. Done with backwards pressure on the plunger, this option is ideal for usually younger patients who need only small amounts of fat removed, Dr. Narins tells Dermatology Times.

“The second way is just to inject tumescent anesthesia and use the liposuction machine to take out the fat,” she says. “The third way is to inject tumescent anesthesia, do liposuction with the machine and excise a little skin in the submental crease. This is great for patients with loose hanging skin.”

Most patients are candidates for one of the first two, Dr. Narins says.

But there are variations on each of the themes.

“With any of those three procedures, I like to do a fat transfer to the chin, with whatever fat I take out. That’s because chins recede as you get older, it uses some of the skin off the neck and gives the neck a better overall appearance,” Dr. Narins says. “In people that need it, I like to use the Silhouette Instalift sutures (Sinclair Pharmaceuticals) to lift up the skin of the neck. Usually I do the fat transfer, and the Instalift is optional.”

For example, Dr. Narins says she wouldn’t use the Instalift in a 30-year-old with just some fat under the neck, because that patient’s skin would retract without help. Rather, she uses the sutures in patients who have some loose skin and in those who might benefit from an excision of neck skin.

“I might do the liposuction, first, with the Instalift; then, see if they need any excision of skin into the submental crease,” she says.

Dr. Narins offers these pearls: For those who need it, use of a tacking suture to the neck and a fat transfer to the chin almost always improves the overall result with liposuction of the neck. And the Instalift significantly improves results for those with loose skin-sometimes, eliminating the need for a submental excision.

Too much loose skin might call for a facelift, Dr. Narins says.

“Most of my patients, especially men, don’t want a facelift. Everybody fits into one of these categories,” she says. “That’s the great thing about these three ways of doing liposuction.”

Disclosure: Dr. Narins was an advisor and investigator for Kybella.