Subcutaneous fat plays a major structural role in facial aesthetics. Like a sheath, it softens, shapes and smoothes the underlying musculoskeletal angles. In young people, the face has an oval shape with a beauty triangle based on the features of the cheekbones and chin. Therefore, the beauty of a woman’s face depends not only on the elasticity, smoothness and absence of wrinkles on the skin, the harmonious curves and roundness of the face are also of great importance.
If present, excess fat deposits will predominate in the lower part of the face and, as a result of gravity, the face looks heavier and fuller, jaw contrast is erased, and the neck-chin connection lacks definition. On the other hand, in cases of fatty atrophy, changes will appear on the lower third of the face, which will look emaciated, flat and angular, and the lack of contrast and curves will cause insufficient grace, read about this on estet-portal.com
- Anatomical risks of cervicofacial lipomodeling
- Criteria for cervicofacial lipomodeling
- The process of cervicofacial lipomodeling
- Complications of cervicofacial lipomodeling
Anatomical risks of cervicofacial lipomodeling
- A continuous zone between the superficial and deep fatty tissue in the malar area.
- Tunnelization that does not run strictly parallel to the skin surface will damage underlying vessels and nerves.
- Crossing the subcutaneous muscles of the neck of the third type poses the same danger.
- The fat under the subcutaneous muscles of the neck is a lymphatic drainage area with the submental and maxillary lymphatic systems. Thus, there is a risk of lymphorrhea (lymph leakage).
- Posterior auricular branch of the facial nerve. This branch can be damaged as a result of postauricular tunneling, which entails paralysis of the occipital muscle and subsequent sagging of the scalp, which is pulled by the forehead muscles.
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- The auricular branch of the superficial cervical plexus. It crosses the posterior border of the sternomastoid muscle, passes along the superficial muscular aponeurotic system and emerges on the surface of the cushion zone. Damage to the branch entails complete loss of sensitivity of the earlobe.
- The facial vein crosses the lower outer border of the submandibular gland. Occasionally, it bends as a result of the superficial cervical aponeurosis, as a result of which it can be damaged.
- Transparotid branches of the facial nerve. These branches pass between the masseter muscle and the superficial muscular neurotic system, where the parotid gland is located in the cellular fascia. There are many anastomoses that provide backup supply if one of these branches is cut off. Only the extreme branches - the maxillary and temporal - are particularly vulnerable. The upper jaw branch crosses the lower edge of the jaw and superficially crosses the facial artery.
Criteria for cervicofacial lipomodeling
From an aesthetic point of view, these criteria are aimed at giving the face a beautiful and youthful appearance. In young people whose skin is firm and elastic, restoration of the normal cervicomental contour by liposuction should follow the criteria developed by Ellenbogen and Carlin:
- clearly defined mandibular border;
- visible sublingual deflection;
- visible thyroid cartilage;
- clearly defined anterior sternomastoid border;
- cervical-mental angle – 105-120 degrees.
In older patients, the reshaping of the three-dimensional image expresses the importance and persistence of fat in any thin face. Sagging skin is important in itself and is most often associated with low cheeks. The quality of the skin will further deteriorate due to loss of moisture.
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A normal cervical-chin contour not only provides an ideal facial oval from the front, but also guarantees a better profile. Correction of chin and jaw ptosis gives better contours to the cheeks. Liposuction is also great for men as they have thicker skin and fewer wrinkles thanks to facial hair.
The process of cervicofacial lipomodeling
At the level of the cheekbones, pinpoint incisions are made in the lower third of the nasomental groove and 2 cm forward within the tragus in the parotid zone. Three cuts are made under the chin: under the tip of the chin, under the upper jaw and opposite the branch that runs up from the lower jaw.
Depending on the shape of the neck, the doctor will determine whether an incision is needed at the end of the cervical-mental angle. In some cases where this angle is acute, an additional incision is necessary to work across the cross-section and obtain retractable scar fibrosis. According to Fournier, it is necessary to get as close as possible to the area that will be treated. Too long exposure to a long cannula can lead to disruption of its horizontal position relative to the surface of the skin and damage to blood vessels or underlying nerves.
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However, Fournier's entry points do not allow the doctor to effectively treat the lower cheeks. The entry point on the lower third of the nasomental groove allows you to effectively target the lower part of the cheeks using tunneling at this level.
The first step of the operation requires gentle tunnelization or non-aspiration cannulation in a cross-section using a 2-mm cannula. Use your free hand to stretch the tissue. First, the procedure is carried out on one half of the face, and then on the second - making it symmetrical to the first.
Second step: lipoaspiration adapted to the shape of the face. First, the chin area is treated, then a digressive action is carried out from the jaw contour to the zygomatic area. The passage of the cannula should be parallel to the skin surface; both entry points at the zygomatic level make it possible to intersect the tunneling surfaces. The surgeon works by palpating the tissue with the thumb and forefinger or by palpation and roller massage, which guides the trajectory of the cannula and thus allows the surgeon to simultaneously operate both at the surface and at depth.
The third step of the operation is a peripheral lift using a classic single-hole cannula. This lifting is carried out at each entry point, allowing treatment of both the neck and lower cheeks, while guaranteeing improved skin firmness. The incisions are sealed with a sterile plaster.
Postoperative procedure
While the patient is still on the operating table, manual lymphatic drainage massage is performed. It should be done three times a week for two weeks. A bandage must be applied for 24 hours.
Complications of cervicofacial lipomodeling
Moderate complications include
- swelling, which usually goes away in 2-6 days;
- subcutaneous hemorrhage, which is usually moderate and localized in the area under the collarbone;
- minimal pain, discomfort.
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However, there are more serious side effects that the doctor should be wary of:
- Facial nerve damage: Pay special attention to the lower part of the upper jaw.
- Hematoma (occurs rarely).
- Complications that may arise from any surgical procedure.
- Maxillary branch of the facial nerve: damage to this can lead to deformation, especially when smiling.
The reason for this is the proximity of the artery and facial vein, which also explains the risk of bleeding during cauterization at this level. Some doctors also warn that the movement of the cannula can cause demyelination of the nerve tissue, which causes immediate problems with facial expressions that can last up to two weeks.
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The medical literature also mentions that excessive aspiration with a classic cannula can have the following consequences:
- unsatisfactory results due to poor conditions or technical inaccuracies.
- pigmentation that gradually disappears if not exposed to sunlight.
- indentations or grooves caused by incisions that are too deep or superficial cannulation.
- temporary partial paralysis, especially at the level of the cervical branch, which entails changes in mouth movements. Goes away in about 6 weeks.
- hematoma.
- infection.
Conclusions:
Lipomodeling tunneling causes ascending scar fibrosis, which changes the oval of the face and the chin area. Cervicofacial lipomodeling allows using non-aspiration cannulation, further adipocyte aspiration and superficial cannulation to restore the oval of the face. The tightening effect is achieved by retracting scar fibrosis. The results of the procedure are excellent and depend on the condition of the patient and the skill of the doctor.
Based on materials from Prime magazine.
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