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Neck liposuction and a neck lift procedure each address specific concerns about the neck and the area under the jaw. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Changes Can Occur in All Layers of the Neck Changes can occur at all layers of the neck with aging. The skin and muscles of the neck loosen, forming bands. Fat accumulates immediately below the skin and deep to the neck muscles. These changes can cause the jawline to lose definition and the neck to appear poorly defined. Neck Liposuction and a Neck Lift are Two Options for the Neck Individuals who present with concerns about their neck and/or the area under their jaw may benefit from either neck liposuction or a neck lift procedure. However, a detailed history and physical exam should always be performed prior to making this decision. Neck Liposuction Alone May Be Good for Younger Individuals Neck liposuction, which involves the careful placement of small incisions hidden under the chin and sometimes behind the earlobes, can be a good option to treat patients who have accumulated fat close to the surface of their skin but with minimal skin and muscle changes. Neck liposuction tends to be a better procedure for younger individuals. This younger patient demonstrated excess fat across her neck and the area under her chin, called the submentum. No excess skin or loose muscle was present. This patient was an excellent candidate for neck liposuction only. She could not be happier with her results only one week after surgery. This younger patient demonstrated excess fat only in the area immediately under her jaw, called the submental area. As a result, she desired a more subtle result. She is thrilled with her results four months after surgery. A Chin Implant with Neck Liposuction Can be a Powerful Procedure for Other Younger Individuals Some people not only have lost definition of their jawline and neck over time but also have a poorly-defined chin. A chin that does not project out adequately relative to the lips and nose can exaggerate the appearance of the jawline and neck. That is why a chin implant and liposuction can be so powerful when paired. The patient of ours below is an excellent example of this. This younger patient not only had concerns about the lack of definition to her jawline and neck, but also demonstrated a weakly projected chin. She received a small chin implant that contoured naturally to her jawline in addition to undergoing liposuction under her jawline and neck. A Neck Lift May be More Appropriate for More Complex Changes A neck lift is meant to address more complex changes to the neck more comprehensively, including the skin, muscle, and both superficial and deep fat. The superficial neck fat is usually removed under direct visualization with specialized instruments during a neck lift in Cincinnati. Performing only liposuction, especially aggressive liposuction, on an individual who is experiencing more complex age-related changes to their neck increases the risk of the skin scarring to the hanging muscle bands, worsening the appearance of the banding. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the neck and face when you have concerns about your neck and/or the area under your jaw. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us

You may have seen images or videos of hemostatic netting online: these images or videos are often extreme and unusual examples of patients who have just undergone a facelift and neck lift who have loops of dark suture quilted across their face and neck. Though they capture people's attention, they are not necessarily good representations of the hemostatic netting technique. The images and videos distract from the reason(s) why surgeons consider using the technique. This blog post seeks to clarify what hemostatic netting is, why it is sometimes used, and where it is typically placed. While evidence of its effectiveness is more limited in the medical literature, the articles that have been published and anecdotal evidence both suggest that hemostatic netting can be effective in reducing the risk of bleeding post-operatively in certain clinical situations. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. A consultation with a well-qualified surgeon will allow you to determine if the following approach is appropriate for you, because this technique may not be appropriate for every patient. Hemostatic (Auersvald) Netting is a Technique Used in Facelift and Neck Lift Surgery A hemostatic net is a technique used in facelift and neck lift surgery. The technique was first described approximately 10 years ago by Brazilian plastic surgeons with the last name Auersvald, hence the nickname for the technique (1). A hemostatic net involves the placement of temporary stitches through the skin and deeper tissue in the face and/or neck after facelift and/or neck lift surgery. A Hemostatic Net is Intended to Reduce the Risk Associated with Bleeding After Surgery The purpose of a hemostatic net is to further reduce the low risk associated with bleeding after facelift and neck lift surgery. This is in addition to the placement of temporary drains. Hemostatic netting reduces the amount of space in which blood could hypothetically accumulate. There is some evidence in the literature demonstrating its effectiveness (1,2). However, there are no official guidelines discussing the appropriate clinical situations in which to use this technique; rather, it is the surgeon's clinical judgement weighing the potential risks and benefits of the technique that determines to which individuals it is recommended. For example, a patient with high blood pressure may benefit more from the placement of hemostatic netting than others though the final decision to place a hemostatic net depends on multiple factors unique to each individual patient. A Hemostatic Net is Loose and Not Permanent It is important to note that these stitches do not remain permanently or even for an extended period. They are removed completely in 48 to 72 hours after surgery along with the drains. It is also important to note that these stitches are not tight. This minimizes discomfort and allows good blood flow to the surrounding skin. A Hemostatic Net is Less Important in the Face After Deep Plane Facelift Surgery One of the benefits of deep plane facelift surgery is that much less skin is lifted off the deeper tissue of the face during surgery. As a result, the connection between the skin and the deeper tissue and, therefore, the blood supply to the skin, remains intact over a larger surface of the face when compared with other, older facelift techniques. As a result, the potential benefit of hemostatic netting in the face with deep plane facelift surgery is less. Instead, hemostatic netting is typically placed only in the area under the chin and in the neck, usually around drains. The dressings placed around the head and neck usually cover them well. This makes the technique much less visible and dramatic appearing than internet images and videos would otherwise suggest. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us References Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plast Surg. 2014 Feb;38(1):1-9. Janssen TJ, Maheshwari K, Sivadasan A, Waterhouse N. Hemostatic Net in Facelift Surgery: A 5-Year Single-Surgeon Experience. Aesthet Surg J. 2023 Apr 11:sjad097.

Dr. Jeffrey Harmon and Dr. Ricci Hoover Lymphatic massage, otherwise known as Manual Lymphatic Drainage (MLD), is increasingly being employed to accelerate the recovery of cosmetic surgery patients, including those who have undergone facelift and neck lift surgery. Starting approximately 4 – 6 weeks after surgery, the goal of MLD therapy is to accelerate the resolution of any remaining post-operative swelling. This is based on the concept, albeit with limited evidence supporting it (1), that a significant contributor to post-operative swelling is the fact that the lymphatic drainage system needs time to heal after surgery. After all, swelling is expected after any surgery in the head and neck. Furthermore, swelling is expected to improve and resolve over a period of weeks to months after facelift and neck lift surgery, regardless of the intervention. MLD is believed to improve the flow of lymphatic fluid away from the treatment site(s) while the body is healing. We at Harmon Facial Plastic Surgery have found this to be one of multiple effective treatment options for normal post-operative swelling in our patients. It is important to have a consultation with your surgeon prior to considering any treatment, including MLD. It is also important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Research on the Effectiveness of MLD is Incomplete and Reported Good Results Real but Anecdotal Almost all the literature on MLD therapy has been on therapy as one component of multi-modality treatment for swollen arms after a mastectomy for breast cancer. A systematic review of the literature including randomized controlled trials (RCTs) utilizing MLD therapy as well as a Cochrane Library review of RCTs concluded that MLD is safe in the treatment of lymphedema after mastectomy. The effectiveness of the therapy was mixed in the studies, partially due to the lack of standardization of methods and outcome measurements (2, 3). The benefits of this therapy in cosmetic surgery are anecdotal and, therefore, will require quality studies to determine its effectiveness definitively. However, the reported benefits from patients and surgeons are such that it is an area of therapy worth exploring, especially because it is a gentle, safe therapy when performed by a trained and certified therapist. It is Important to Have a Trained, Certified Lymphedema Specialist Perform MLD It is important that a trained, certified lymphedema therapist perform MLD therapy. A certified lymphedema physical therapist (CLT) is someone who has earned their doctorate in physical therapy and has gone on to become certified in MLD. The certification is a ten-day, twelve hour per day course that includes education on the anatomy and physiology of the lymphatic system as well as the various sequences of manual treatments for lymphatic drainage. MLD Consists of Gentle Hand Movements Over the Face and Neck MLD consists of gentle hand movements over the face and neck. There are four major methods of MLD, including the Volder, Foldi, Casey-Smith, and Leduc methods. Each method involves slightly different hand movements. The physiological mechanism of treatment with these methods is poorly studied and, therefore, poorly understood. However, as previously explained, each of these methods has long been implemented in the context of multi-modality therapy for post-mastectomy patients with arm swelling. There are four total hand strokes and techniques that are used to affect the lymphatic system: stationary circles, pump technique, rotary technique, and scoop technique. A combination of strokes is used in different areas of the body. They can all be used during one treatment session if the practitioner sees fit. However, the primary method used in the head and neck is stationary circles. The average number of therapy sessions is three to four. The CLT may then teach patients how to perform a modified version of this therapy at their home. Patients usually feel relaxed during each MLD therapy session. It is normal to feel a cold sensation or tingling where MLD is performed. Patients may also feel tired after treatment. There are Instances in Which MLD is Not Appropriate MLD is not appropriate for patients with acute infections, untreated or incompletely treated cancer, cardiac problems including, but not limited to, arrhythmias, or poorly controlled hyperthyroidism. MLD is One Component of Multi-Modality Therapy for Expected Post-Operative Swelling It is also important that MLD be only one component of multi-modality therapy to treat normal or abnormal post-operative swelling. One important component of multi-modality therapy is time, as the swelling is secondary to a typically normal healing process that simply requires time to resolve in most cases. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation for Facial Plastic Surgery with Dr. Jeffrey Harmon Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching "plastic surgery near me." Get in touch with us to learn more. Contact Us Request a Consultation for MLD with Dr. Ricci Hoover at Elevate Physical Therapy Request a consultation with Ricci Hoover, PT, DPT, CLT at Elevate Physical Therapy in Blue Ash, Ohio if have questions about MLD, including whether it may be appropriate for you. Email: @elevatepelvicpt Instagram: ricci@elevatepelvicpt.com References Meade RA, Teotia SS, Griffeth LK, Barton FE. Facelift and patterns of lymphatic drainage. Aesthet Surg J. 2012 Jan;32(1):39-45. Thompson B, Gaitatzis K, Janse de Jonge X, Blackwell R, Koelmeyer LA. Manual lymphatic drainage treatment for lymphedema: a systematic review of the literature. J Cancer Surviv. 2021 Apr;15(2):244-258. Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev. 2015 May 21

The neck is a common area patients seek improvements in with surgery. Signs of aging in the neck are the result of loosening muscle and skin and sometimes the accumulation of fat. The medical literature recognizes youthful contours and angles to the neck and jawline which surgeons can strive for. However, all patients are not born with these features. In fact, there probably is no true "ideal" neck which every patient possesses in youth. There are many approaches to a neck lift. My approach is through a deep plane neck lift in the central neck in addition to a deep plane lift of the sides of the neck through the extended deep plane facelift. I feel this approach can provide the most comprehensive and longest-lasting improvements in the appearance of the neck. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. It is important to have a discussion with your surgeon about what can and cannot be accomplished with surgery to treat age-related changes to the neck. Tight Muscle and Skin Tight platysma muscle and skin contribute to a youthful-appearing neck. The platysma muscle is a long, thin muscle that wraps around the front and sides of the neck. It is weakest at the center. Most age-related changes to the platysma muscle occur when the center of the muscle weakens. This results in a separation of the muscle fibers from the center of the neck resulting in banding. Banding appears as thick, ropy folds in the center of the neck that can be more limited to the upper part of the neck or extend down low in the neck. The skin follows the loosening of the platysma muscle. Sharp Angle between the Jawline and Neck The angle between the more horizontal jawline and the more vertical neck is called the cervicomental angle. An aesthetically "ideal" angle is acute, with the soft tissue under the jawline tucked up between the jaw bones and the skin and platysma muscle tight against the neck. Age results in a blunting of the cervicomental angle, regardless of where it started. This can be due to loosening of the platysma muscle resulting in banding, the accumulation of fat deep to and superficial to this muscle, and loosening skin. The horizontal location of the soft tissue – whether it is tucked up under the jawline or rests below it – is dependent on the patient's natural anatomy. Some individuals may have more soft tissue that sits below the jawline from an early age. Visible Thyroid Notch The thyroid notch is a small depression above the cartilage, called the thyroid cartilage, and below the cervicomental angle. It is less visible in women versus men because men have a more prominent thyroid cartilage. The thyroid notch reflects the tight attachment of the soft tissue of the neck just below the cervicomental angle. Loosening of skin and muscle in the neck due to aging reduces the appearance of the thyroid notch. Tightening of the muscle and skin can improve the appearance of it. Every Neck is Different Every individual is born with different neck features. Some individuals were born with a sharp cervicomental angle and little soft tissue hanging below the jawline. Others were born with a blunter cervicomental angle and, therefore, a more poorly defined neck. A blunted cervicomental angle can be due to the location of a bone, called the hyoid bone, which sits above the thyroid cartilage. When the hyoid bone sits up and back in the neck a sharper cervicomental angle is possible. However, some individuals are born with a hyoid that sits down and forward, creating a naturally more blunted cervicomental angle. All the deeper muscles of the neck radiate from this bone, which is what sets the cervicomental angle in the first place. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! CONTACT US