INTRODUCTION
Neck rejuvenation is becoming increasingly popular
for individuals in their 40’s and older. As the neck
ages, it loses the well-defined contours seen in youth.
One apparent change is in the cervicomental angle—the angle
formed by the horizontal plane of the submental region and the
vertical plane of the neck. In classical beauty, a cervicomental
angle of 105° is generally considered the “ideal†representation
of a youthful and beautiful neck.1 Over time, the cervicomental
angle becomes blunted and more obtuse, resulting in the loss
of the youthful-appearing neck. In addition, descent of the skin
and soft tissues of the lower face create jowls and the loss of a
well-defined, youthful jawline. Subcutaneous and sub-platysmal
fat deposits can progressively increase, leading to excessive
fullness in the submental area.
Until recently, surgery has been the mainstay of neck rejuvenation.
2 However, many individuals are reluctant to undergo
surgery due to various factors including the invasiveness and
recovery time, while others may not be good candidates for
surgery due to medical contraindications such as uncontrolled
hypertension or use of anticoagulant medications.3
Laser lipolysis has emerged as a proven modality for treatment
of excess fat and cellulite for those who do not wish to undergo
open surgery. For neck rejuvenation, laser lipolysis provides the
benefits of both removal of subcutaneous fat as well as tightening
of the skin to reduce skin laxity. These results are achieved
via two primary mechanisms: liquefaction of the adipose tissue
and collagen remodeling.4 The laser delivers energy in the
form of heat to the tissue via an optical fiber within a cannula.
This heat is absorbed by adipocytes resulting in damage to the
cell membranes. The cell membranes rupture and the liquefied
fat can then be removed via simple manual manipulation.5 The
laser energy also serves to denature adipose and dermal collagen,
resulting in its remodeling and contraction. This becomes
clinically evident as skin tightening.5,6
Multiple laser lipolysis devices are available. There are two main
systems–diode and neodymium-dosed yttrium aluminum garnet
(Nd:YAG)—with the primary difference being that the diode devices
deliver shorter wavelengths in the electromagnetic spectrum
than the Nd:YAG devices. The wavelengths delivered by these
devices range from 920nm to 1444nm. There has been much dis-
