Neck rejuvenation is becoming increasingly popular for individuals in their 40â€™s and older. As the neck ages, it loses the well-defined contours seen in youth. One apparent change is in the cervicomental angleâ€”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 105Â° is generally considered the â€œidealâ€ 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 systemsâ€“diode and neodymium-dosed yttrium aluminum garnet (Nd:YAG)â€”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-