Although the focus of this chapter is the aesthetic use of liposuction in the head and neck area, liposuction as a technique may also be used to manage a variety of other surgical prob-lems. It can be used to elevate soft tissue facelift flaps atraumatically9 or to defat pedicled or free flaps,21 and is effective for removal of benign fatty tumors.22,23When used as a closed technique, with absence of muscle or superficial musculoaponemotic system (SMAS) manipulation, liposuction's greatest effectiveness is seen in creating contour changes in the cervicomental angle and, when used judiciously, in the jowl region. The open technique implies suction-assisted fat extraction under direct vision generally in association with rhytidectomy. The nasolabial folds and the lower jowl fat pads have both been addressed with the use of closed liposuction with less predictable results and absence of controlled long-term follow-up. Nasolabial fold prominence is usually a gravity problem, and although liposuction results vary, judicious liposuction here may be helpful. The natural tendency for progressive atrophy of facial fat5,8,17 makes midface liposuction risky. The concept of improving the facial contour may even necessitate increasing facial dimensions; in the patient with low body fat or the older patient with significant fat atrophy, facial fat injections or submalar implants may provide the appropriate rejuvenating maneuvers.
Ideal candidates for primary liposuction of the cervicofacial region exhibit sufficient skin elasticity to promote skin contraction. In those patients with moderate or poor skin elasticity, removal of localized adiposity may predispose to an increased appearance of sagging skin. Some erroneously promote liposuction as a procedure to reduce sagging skin24 whereas it can compound the problem. Dedo suggests that after the age of 40 years the contractile ability of skin may become unsatisfactory.5 Others suggest that age be taken into consideration but rely on actual tissue assessment as the predictive factor.10,25 Occasionally, the young patient with apparently good skin elasticity may have limited results. Patients should be aware that good results are not totally predictable.
As an adjunctive procedure in facelift surgery or when combined with chin augmentation, liposuction enhances the cosmetic result. As a primary procedure, cervicofacial lipo-suction has also led to marked improvement in facial rejuve-nation by redefining the youthful angles and contours of localized adiposity with minimal recuperation time and mor-bidity. The scholarly work in the field of liposuction has decreased complications markedly and has continued to provide improvement in operative outcomes.
