Q. Will this fat pad go away if I lose weight?
- The fat pad will get smaller, just as fat cells everywhere get smaller as you lose weight. However, there will still be an excess of fat cells, even at lower weights, so the problem is unlikely to go away completely. It is, after all, a genetically determined concentration of fat cells that is causing the problem. Most patients are aware that they had extra fat in this location even when they were much younger or in excellent physical condition. It makes them look pudgy, not lean and fit. Fortunately, this problem is well treated by a submental lipectomy.
Q. Will the fat come back?
- The fat cells that are removed are gone forever. The remaining fat cells will swell and shrink in response to your overall weight gain or loss. But whatever your weight, the contour under your chin will always be better than it would have been without the submental lipectomy because there is a permanent improvement in proportions.
Q. How long is the scar?
- The scar is typically two to three centimeters long (about an inch). It is possible to use a shorter scar if liposuction is done without direct excision of fat tissue and tightening of the platysma muscle sling, but these maneovres are so helpful that they justify a slightly longer incision. If the incision is placed in the crease under the chin and not farther down where it might be seen on the neck, it is inconspicuous.
Q. Is it painful?
- Usually this procedure is not very painful, although there is a tight sensation in the neck.
Q. Will this procedure also tighten the skin, or will it make the skin tone worse?
- A submental lipectomy removes fat and tightens the muscle sling. It does not remove extra skin. For older patients, who have loose skin that needs to be addressed, a facelift is recommended (a facelift tightens the skin of the neck). A facelift typically includes a submental lipectomy. Sometimes patients may not be ready for a facelift and wish to do something less. They may still have a submental lipectomy to improve their profile, recognizing that they may want to return in a few years to have the skin laxity addressed. You might wonder whether removing the fat makes the overlying skin more lax. Fortunately, although there may be no skin tightening, the skin is unlikely to be looser either.
Q. Is there a laser that could be used to minimize downtime?
- Lasers have been adapted for use with liposuction (SmartLipoTM). The concept is that the laser energy helps seal blood vessels and possibly provides some tightening effect. If there is less bruising, this would be expected to minimize the time off work for patients who don't want to return to work with obvious bruising. However, it is best in almost all cases to tighten the muscle simultaneously and even remove a small amount of submuscular fat to produce a more defined neckline. Therefore, there is no real benefit in using the laser if there is going to be some postsurgical bruising from the submental lipectomy and muscle repair anyway. The duration of bruising is only a matter of days, so it is not a major issue. Patients are willing to tolerate a little more bruising and swelling if the result is going to be better.
Q. Do you do anything to the muscle?
- Yes, I sew the edges of the muscle together in the midline of the neck, like a zipper. These muscle borders tend to be genetically separate ("decussation" of fibers) and can even let fat hang between the borders in later years causing an unsightly turkey waddle (any similarity to turkey anatomy being unattractive in humans). The benefit of the muscle repair is threefold – removal of some submuscular fat, tightening of the neckline (the effect is transmitted to the overlying skin), and as a preventative measure to avoid the turkey waddle deformity later on.
Q. How long do I need to take off work?
- The swelling is not usually the limiting factor because even with maximum swelling the day after surgery, there is usually less fullness than there was before surgery. Patients and family members can usually see a pleasing difference already when the chin strap comes off in the office the day after surgery. The duration of bruising tends to set the recovery time. Bruising typically accumulates in the lower neck, due to the influence of gravity, not right under the chin where you might expect. It usually takes about ten days for this bruising to fade, but it can take much longer in older patients. Fortunately, most of the bruising may be hidden by clothing.
Q. Will people be able to tell I had surgery?
- The incision is typically well hidden under the chin where there is often a crease anyway. At first, the scar is a little bumpy. The scar gradually flattens with time, the redness fades, and the irregularities smooth out. After surgery, people invariably think you lost weight, not that you had liposuction under your chin.