SUBMENTAL LIPOSUCTION, AN ALTERNATIVE TO LIPOLYSIS WITH MESOTHERAPY INJECTIONS OR A COMPLEX SURGERY?
Keywords:
Liposuction, platysma, complications, retraction, toningAbstract
Submental liposuction, which can be performed alone or as part of a neck lift, is a procedure that contours the jawline and cervicomental angle by removing fat tissue using the tumescent technique. As with any aesthetic procedure, a complete physical examination of the neck is essential for proper patient selection and achieving excellent results. This technique is usually applied to younger patients who have toned skin, elasticity, the ability to contract, and good adherence of the skin to the underlying structures. We treated 20 patients in our practice with submental liposuction, either as a single procedure or combined with a neck lift, to improve the contour of the submental and neck area. We monitored long-term results as well as patient satisfaction, complications, and side effects.
A thorough examination is essential because some conditions cannot be treated with liposuction alone, and it is important for patients to be prepared to avoid disappointment. Very thin skin, “like onion peel,” predicts a poor outcome except in cases combined with lifting. The presence of multiple and deep horizontal or oblique wrinkles on the neck indicates that the skin will not retract properly after surgery. With aging, fat may accumulate above or below the platysma. Fat above the platysma can be easily removed through liposuction. With the neck in extension, we assess whether the fat is above or below the platysma. Typically, a medium fat thickness of 1.5–2.0 cm in the pinch test is indicative of a good outcome. A low position of the hyoid–thyroid complex may limit the achievement of a clear cervicomental angle, compromising the final result.
In patients with visible platysmal bands, whether or not there is animation, liposuction should be performed carefully as it may accentuate this deformity. In those with prominent submandibular glands, aggressive liposuction may make them more visible.
Submental liposuction should be performed with limits. Excessive fat removal can cause contour irregularities or make the neck appear excessively thin (skeleton effect). What may seem like a minimally invasive and not very complex procedure to a non-specialist in plastic surgery can result in disappointment and loss of trust in plastic surgery. Special attention should be paid to aesthetic complications, which have as much impact on the patient’s psychology as hematomas, infections, and other complications.
References
Borisenko AS, et al. (2024). Isolated Medial Platysmaplasty and Harmonization of the Lower Third of Face with Local Fat Autograft: A Case Report. Plastic & Reconstructive Surgery Global Open. Discusses combining platysmaplasty with fat grafting and liposuction of the cervicomental area; covers outcomes, safety, and long-term aesthetic improvements. DOI: 10.1097/GOX.0000000000005897
de Almeida AT, et al. (2025). Platysma Prominence: Review and Expert Analysis of Clinical Presentation, Burden, and Treatment Considerations. doi: 10.1097/GOX.0000000000006490
Draelos, Z. D. (2016) Cosmetic Dermatology: Products and Procedures, Second. Wiley Blackwell. 978-1-118-65558-0
Duarte MG, et al. (2025). Complications and Challenges of Submental Liposuction: A Literature Review. Brazilian Journal of Implantology and Health Sciences. A more comprehensive recent survey of complications – hematomas, seromas, nerve injuries, contour irregularities, etc. https://doi.org/10.36557/2674-8169.2025v7n3p1695-1706
Erian, A., & Shiffman, M. A. (Eds.). (n.d.). (2012) Advanced surgical facial rejuvenation. Springer. 978-3-642-17838-2
Fijany AJ, et al. (2025). Comparison of Patient Reviews for Submental Liposuction vs Kybella. (Aesthetic Surgery Journal). https://doi.org/10.1093/asj/sjaf129.
Guyuron, B., Eriksson, E., Persing, J., et al. (2009). Plastic surgery: Indications and practice. Elsevier. 978-1-4160-4081-1
Hazani,R., Mrad, M.A., Tauber, D., Ulm, J., Yan, A., Yaremchuk, M. J. (2016) Clinical Diagnosis in Plastic Surgery. Springer. 978-3-319-17094-7
Neligan, P. C. (2018) Plastic Surgery- 6 Volume Set, Volume 2. Elsevier. 978-0-323-35702-9
Park, J. Y. (2018) Liposuction. Springer. 978-981-10-6860-7
Shiffman, M. A., Mirrafati, S. J., Lam, S. M. (2008) Simplified Facial Rejuvenation. Springer. 978-3-540-71096-7
Tettamanzi M, et al. (2024). Advancements in Face and Neck Contouring: Integrating Radiofrequency-Assisted Liposuction with FaceTite and Buccal Fat Pad Excision for Facial Slimming. Volume 48, pages 4667–4674 https://doi.org/10.1007/s00266-024-04245-1
Tiran, T. A., Panthaki, Z. J., Hoballah, J. J., & Thaller, S. R. (n.d.). (2017) Operative dictations in plastic and reconstructive surgery. Springer, 978-3-319-40631-2
Truswell, W. H. (2009) Surgical Facial Rejuvenation. Thieme. 978-3-319-18035-9
Viana JVH, et al. (2024). Complications in submental liposuction: A narrative review.
A review focusing on complications specific to submental liposuction: edema, infections, sensory changes, etc. DOI: https://doi.org/10.33448/rsd-v13i11.47333
Wong, F. & Brian J.,Arnold M. G, Boeckman J. O. (2016) Facial Plastic and Reconstructive Surgery. Springer. 978-3-319-18035-9
