Treatment of the sub-chin, lower jaw and neck

Initial neck treatment includes correction of submandibular and sub-chiropractic lipoptosis. Facelift type I almost does not require any interference on the neck. The tension of the skin-in-the-muscle-subcutaneous muscle complex is all that is required for an ordinary patient. However, in most patients, attention should be paid to lipoptosis in the sub-chin, submandibular and mandibular areas.

If only a reduction in the volume of this lowering fat is required, a 1 cm cut is made in the sub-chin, allowing a cannula for liposuction. If the examination shows that there is no excess of subcutaneous muscle and the skin retains some elasticity, liposuction is performed as the only procedure. First, dissection is carried out for 1 cm immediately under the skin, in the middle of the subcutaneous fat layer. Small (1 cm) tunnels are formed into which cannulas 2-3 mm in diameter are then inserted for liposuction. First, tunnels running from the sub-chin area through the edges of the lower jaw into the cheek area, toward the anterior edges of the sternocleidomastoid muscles and downward, through the cervical-chin angle to the thyroid cartilage region, are created without the use of suction. This is done fan-shaped, from one cheek through the neck to the opposite cheek. Then, a round cannula with three holes located on one side is used to perform liposuction. In the cheek area, very careful and reasonable liposuction is performed, with the removal of the tissues from the edge of the mandibular bone, so as not to injure the mandibular nerve. To prevent the creation of any furrows, tunnels or impressions, minimal uniform liposuction is done. Their education most easily can occur in the areas of the cheeks, so here one must be especially careful. Depending on the amount of liposuction required in the sub-chin and submaxillary areas, a larger cannula may be required. To achieve adequate fat removal and contouring, a 4 mm, and sometimes 6 mm flat cannula with one hole on the bottom surface is required. To check the uniformity and symmetry of fat removal, two-hand palpation is required. To give the skin a soft, natural contour, it is required to leave a thin layer of subcutaneous fat. It is necessary to ensure that the volume of liposuction in the cervical-chin angle is not too large, since this can cause skin damage and subcutaneous scarring, followed by the development of striation.

Often this is all that is required for type II surgical facelift. However, with the expanded, type III braces performed in the presence of a large amount of fat and some lowering of the subcutaneous muscle, and also in type III, with significant accumulations of fat, sagging of the skin and subcutaneous muscle, additional work is required. Implied extension of the cut to not less than 2.5-3 cm. Then, after liposuction, a direct lifting of the skin over the subcutaneous muscle is performed. This is done widely, usually to the front edges of the sternocleidomastoid muscles and the cervical-chin angle, which allows the surgeon to directly see the remaining areas of lipoptosis under the subcutaneous muscle, as well as the excess and weakness of the front beams of the subcutaneous muscle. Their discrepancy can be seen very well. The excess and weakness of these tissues have been established. With the help of the grip and long curved Kelly clamp, the tissues are pulled to the middle line. Their excess is excised with adequate hemostasis. Then, along the middle line, the front edges of the subcutaneous muscle are sewn together. Excess fat and muscle is removed all over the back, up to the cervico-chin angle. Several mattress sutures are applied with the Vicril 3/0 thread. After the creation of a strong muscular corset and a sharper cervical-chin angle, the intersection of the entire skin array left for the brach may be performed from the rear. Excess skin in the sub-frontal area will be installed at the end of the operation, after the bilateral tension of the anterior and posterior skin in the direction of the back and up.