25. Liposuction and immediate implantation of an elastic thread between the two fasciae of Loré to treat a double chin
KEYWORDS: double chin surgery, double chin lifting, neck liposuction, neck lift with elastic thread.
The accumulation of fat in the anterior region of the neck can be very unsightly. This defect, known as a double chin, can now be corrected by means of liposuction and the immediate implantation of a suspensive elastic thread, which immediately redefines the cervicomandibular angle. The thread is implanted through an incision 1 cm in length behind the lobe of one ear. This ambulatory procedure is performed under local anaesthesia.
Liposuction is carried out through two horizontal incisions a few mm in length at the sides of the double chin. One incision will be used to aspirate the fat under the chin; the other, lower than the first, will enable the operator to aspirate the fat located beneath the cervicomandibular line.
A 10 mL syringe is used to aspirate the fat. The aspiration cannula has a small diameter, about 2 mm. Performing liposuction through a small cannula takes longer, but has the advantage that numerous horizontal tunnels can be created. These tunnels give rise to horizontal retraction of the skin, which is essential to obtaining the desired result. In the past, this procedure would have terminated with liposuction; the patient would have worn a compressive bandage for two weeks and the result would have been seen a few months later. Today, however, the implantation of an elastic thread between the two fasciae of Loré means that the result is immediate and the cervicomandibular angle is far better defined. Elastic suspension eliminates the weight of the underlying tissues, thereby enabling the tissues that have undergone liposuction to retract completely and rapidly.
As always, the elastic thread is implanted through a 1 cm incision behind the lobe of one ear. The skin above the fascia of Loré is dissected. The dissected skin is lifted with a retractor and a 16.5 cm two-tipped Jano needle is inserted into the cavity. The needle follows the design of the cervicomandibular angle.
The Jano needle is partially extracted and the elastic thread is pulled through. The depth-marks on the shaft of the needle are counted. The posterior tip of the needle now becomes anterior and passes through the fascia of Loré, anchoring the elastic thread. The needle then continues along its pathway deep beneath the cervicomandibular angle, following the preoperative design. The needle is partially extracted and the elastic thread is pulled through. When ½ cm of the posterior tip remains in the tissue, the Jano needle is rotated through 180° and continues to travel along the preoperative line. The two-tipped needle partially emerges. The elastic thread is pulled through and placed under tension. Again, the needle is rotated through 180° and travels towards the contralateral fascia of Loré. In this case, the operator has kept the needle too superficial, and the assistant points out an introflection of the skin. The operator therefore pulls the needle back and repositions it more deeply. No introflection of the skin can now be seen and the Jano needle completes its pathway, partially emerging at the level of the tragus. The operator counts the depth-marks. When 1 cm of the tip remains in the tissues, the needle penetrates the fascia of Loré and follows a pathway located about 1 cm above the previous one. The two-tipped needle partially emerges, avoiding the incision used for liposuction. The elastic thread is pulled through and placed under tension. The operator tugs on the thread several times to ensure that it is firmly anchored to the fascia of Loré. The depth-marks on the needle are counted. The needle is rotated through 180° and continues along its pathway. The two-tipped needle is partially extracted and the elastic thread is pulled through. The depth-marks on the needle are counted; when ½ cm of the tip remains in the tissues, the needle is rotated through 180° and continues in the direction of the fascia of Loré, where it penetrates the cavity created by means of the initial dissection. The two-tipped needle partially emerges in front of the tragus. The elastic thread is placed under tension. The operator counts the depth-marks. When 1 cm of the tip remains in the tissues, the Jano needle is rotated in the cavity lifted by the retractor and emerges from the initial incision. The two ends of the elastic thread are placed under tension and knotted.
The neck appears perfectly defined. Massaging from the centre outwards distends the skin along the elastic thread stretched between the two fasciae of Loré. The operator sutures the small incision with a re-absorbable thread.
The result is immediate and optimal. Six months later, the advantages of the elastic procedure are evident. Although the patient has lost weight, the cervicomandibular angle remains perfectly well-defined and the mandibular arch is clearly delineated. Immediate suspension of the neck has enabled perfect and rapid.
Capurro S., Rava C. (2013): 25. Liposuction and immediate implantation of an elastic thread between the two fasciae of Loré to treat a double chin. CRPUB Medical Video Journal. Elastic Plastic Surgery section. http://www.crpub.org
How long does the effect of suspension of the neck tissues with the elastic thread last?
Suspension is permanent because it is carried out between two fixed points, the two fasciae of Loré.
What advantages does using the suspensive elastic thread have over the traditional procedure?
Suspensive elastic neck lifting after liposuction to treat a double chin enables an excellent result to be achieved immediately. The cervicomandibular angle is much better defined and the jaw also becomes well delineated. By eliminating the weight of the tissues, elastic suspension allows complete retraction of the area subjected to liposuction. The elastic thread is neither visible nor palpable, and becomes integrated into the tissues within a few weeks after implantation.
In patients with excess skin, might it be useful to run the liposuction cannula through several times, without aspirating, in order to facilitate retraction of the skin?
Yes, it could be very effective. Reducing the subcutaneous tissue could be useful in any case. Moreover, slackness of the platysma muscle and skin under the chin can easily be corrected by implanting another two elastic traction threads and anchoring them to the two fasciae of Loré.
How do you draw out the exact pathway where the suspensive elastic thread is to be implanted?
The surgeon and the assistant press the skin upwards above the angle of the jaw. The patient has to bend his neck until the cervicomandibular angle appears; this is then marked out with a dermographic pen.
In cases of “turkey neck”, is there no longer any need to make an incision under the chin and to remove a portion of the platysma?
An incision under the chin is almost never made. The elastic thread is able to suspend the tissues of the neck, restoring them to their original position. All defects can be corrected by means of the elastic thread, without blunt dissection and without the removal of skin. In the most severe cases, the skin can be treated by means of Electroporo Cosmesis, followed by the application of resorcin. When the skin is no longer subjected to the pull of gravity, it rapidly shortens and is remodelled.
This procedure yields the best possible results. After horizontal liposuction, which is carried out by means of a 2 mm diameter cannula, elastic lifting of the neck is performed through an 8 mm incision behind the lobe of one ear. Elastic lifting of the neck creates a pleasing cervicomandibular angle. An elasticated bandage is worn for a few weeks. (31/10/19)