A man can be lean and fit and still have a heavy neck. Often the fullness sits beneath the platysma muscle, where liposuction cannot reach it. When that deeper tissue is what hides the jawline, tightening the muscle over it only gets you so far.
Many surgeons concentrate their neck lift on superficial fat removal and platysma tightening, because that’s easier than addressing the deeper structures that truly cause the problem. At Wes Plastic Surgery, I work beneath the muscle. Deep fat, the digastric muscles under the chin, and the submandibular glands can each contribute to the bulk, so I assess all three rather than assuming the neck simply needs a tighter pull.
The superficial fat right under the skin, the fat that most people do liposuction on, is a different story. I usually want to keep it. That layer cushions the skin over the muscle and gives the neck a smooth surface, especially in motion. Stripping it away can leave a neck that looks leaner but shows uneven contours and scars in an unsatisfactory way. A sharp jawline loses something if the neck beneath it looks overoperated.
Through the deeper dissection, I remove excess fat under direct vision. Bulky digastric muscles may also need reduction, though some patients need very little work there.
Then there is the fullness just under the jaw that patients sometimes point to after a previous neck lift. You may feel this below your jawline, a few centimeters in front of your earlobe. Often this fullness is the submandibular gland. These glands produce saliva, and when they are prominent or sit low, removing more fat around them will not solve the problem. A lot of research has shown that these glands grow as we age, so in my mind, the rational thing to do is reduce i to above the level of the jawline while leaving the rest of the gland in place. Gland reduction is complex, and you should make sure your surgeon who is doing it does it often, as the gland sits near some critical structures in the neck.
Once the deeper sculpting is complete, I repair the platysma in the midline. By then, the shape is already there. The muscle repair refines it, and the fat preserved beneath the skin provides a smooth covering. The goal is a jawline that stands out without a neck that looks natural and youthful.
