Swan-Neck Surgery: What It Is, Who It Suits, and the First Week

The short answer

Swan-neck surgery is the name Clair Plastic Surgery (클레어성형외과), near Gangnam Station in Seoul, uses for one operation that treats the area under the chin in two steps. The first step removes fat. The second tightens the platysma, the thin sheet of muscle that runs under the chin and down the front of the neck, when it has become loose. The fat removal itself covers two layers. Fat just under the skin is removed by liposuction through small openings, and a deeper layer of fat that sits behind the platysma is taken out by hand, piece by piece, which the clinic calls grape-cluster fat removal. Tightening the muscle needs a small incision of about 1 to 2 cm under the chin, so this is not an incision-free operation.

The clinic lists the operation as taking from 60 minutes, under intravenous sedation. Stitches come out on day 5. You can fly home from the day after surgery, but being able to fly is not the same as being recovered. The recovery period the clinic gives is about one week, and early swelling and bruising generally start to ease after 3 to 7 days, depending on your constitution and the extent of surgery. Consultation, the operation and the check before you leave are all done by the representative director, Dr. JinHo Han, a board-certified plastic surgeon. Whether the operation suits you, and which parts of it you need, is decided only after examination.

What happens in each layer

A double chin usually comes from one of two things, or from both. There may be more fat under the chin, or the platysma underneath may have loosened. Seen from the side, the clinic describes three layers: fat just under the skin, then the platysma, then fat hidden behind the muscle. Liposuction deals only with fat. If a loose muscle is part of the cause, removing fat leaves that part unchanged, which is why the two steps are planned together.

Step 1a: the fat under the skin. Liposuction is done through small openings behind both earlobes and under the chin. The clinic uses an LSSA device, a liposuction device that works with ultrasound energy. A solution is first placed into the fat layer, the ultrasound probe then separates and softens the fat, and a fine cannula removes it. The line from the jaw to the neck is then checked from the front, at 45 degrees and from the side. In the clinic's own description, the device is a tool for handling fat more finely, and using the same device does not give everyone the same result.

Step 1b: the fat behind the muscle. This deeper fat is not suctioned. The clinic's explanation is that the space under the chin is small and several structures sit close together in it, so this layer is checked directly and the parts that need to come out are removed piece by piece, a little like picking grapes from a bunch. "Grape-cluster fat" is not a diagnosis. It is a plain way of describing how this fat can look once it is reached. How much of it there is, and where, differs from person to person, and the amount removed is decided within the range that is needed rather than by taking as much as possible.

Step 2: the platysma. The loose muscle is gathered toward the middle and stitched in place. This is the part that needs the incision under the chin, and the suturing is done by Dr. Han.

The table puts the steps side by side.

How fat and loose muscle are told apart

A common question is whether a double chin is simply fat. Before answering, Dr. Han uses ultrasound and examination to look at three things: how much fat there is under the chin, whether the platysma has loosened, and whether both are present. Fat and a loose muscle often occur together, so the two are assessed side by side rather than one at a time. Skin elasticity is also checked before any plan is made.

Where the fat sits differs between people, so the area of liposuction is planned for each face. The aim is an amount that fits the balance of the whole face, not the largest amount possible. A plan is proposed only after the ultrasound check and the examination, never from appearance or photos alone, and the clinic's stated approach is to recommend only the range of surgery that is needed.

The ultrasound used at this stage is an imaging check. It is not the ultrasound energy in the LSSA device used during liposuction, and it is different again from the focused-ultrasound devices used for non-surgical lifting, which we compared with threads and radiofrequency in Thread, Ultrasound or Radiofrequency: How Lifting Methods Differ.

The clinic's pages describe the operation as usually being considered by people who:

• feel that a double chin makes the face look heavier
• find that fat on the face does not come off easily even with dieting
• are concerned about sagging and a double chin at the same time

These describe who tends to ask, not who qualifies. Sometimes the examination points to a smaller plan, a different approach or waiting. We wrote about that kind of outcome in When a Consultation Ends With "Not Now".

Three questions worth asking at consultation:

1. Is there a lot of fat under my chin?
2. Is the muscle under my chin loose?
3. Does the muscle need to be treated as well?

Sedation and monitoring: a common question for patients from Taiwan

Among patients from Taiwan, anesthesia is one of the most common worries, and the question is usually direct. Is there a separate anesthesiologist, and if not, is that acceptable? Feeling uneasy when the arrangement differs from what you know at home is reasonable. Taiwan and Korea have different anesthesia systems, so it helps to know how it works here and what the clinic actually does.

In Korea, the type of anesthesia is chosen according to the procedure and the patient's condition, from local anesthesia, intravenous sedation or general anesthesia. Swan-neck surgery is done under intravenous sedation. If your health or the planned extent of surgery makes sedation unsuitable, another method is considered. Anesthesia in Korea, including sedation, may only be given by a doctor. Korean law has no rule that it must be given by an anesthesiologist, but that fact alone does not tell you how a particular clinic handles it. At consultation, confirm who is responsible for the anesthesia and what is checked during surgery.

Asked whether sedation without an anesthesiologist is acceptable, Dr. Han's answer is that it cannot be judged that simply. Whether an anesthesiologist is present is one fact. Which anesthesia is used, and how your condition is checked during surgery, matter as much. Sedation is not a matter of putting someone to sleep and starting to operate. This is what the clinic says it does:

• Once a surgery date is set, your current medicines and surgical history are checked in advance, and the precautions and any medicine instructions are explained.
• Before surgery, the anesthesia method and the process are explained to you.
• On the day, before going in, your blood pressure and oxygen saturation are checked by the director together with two nurses.
• During surgery, two monitoring devices are used to track blood pressure, heart rate, ECG and oxygen saturation continuously.
• The emergency kit is checked every week, and emergency training is carried out.
• Under Korean law, operating rooms where surgery is done under sedation have CCTV, and the operation is recorded if you ask for it before surgery. Recordings do not normally include sound, and viewing or release is limited to cases set out in the law.
• Before you leave, your condition after surgery is checked.

Sedation is still anesthesia. It carries risks such as slowed breathing and a drop in blood pressure, and both the side effects of anesthesia and recovery from it differ from person to person. If anesthesia worries you, raise it at consultation. Useful questions are which anesthesia will be used for you, who is responsible for it and what is monitored during surgery, and what happens if this type of anesthesia does not suit you.

The incision, the stitches and scars

There are two kinds of opening. Liposuction is done through small openings behind both earlobes and under the chin. Tightening the platysma needs a separate small incision under the chin of about 1 to 2 cm. Because of that incision, the clinic does not describe swan-neck surgery as incision-free. The exact position and size can vary with the method and with the individual.

Dr. Han closes the incision himself, and the stitches come out on day 5 after surgery. Scars differ with skin characteristics and with how healing goes, so no single description applies to everyone. Dr. Han explains where the incision will be and what to expect of the scar at consultation. It is worth asking about the incision and aftercare as directly as you ask how much fat will be removed.

The first week, and flying home

The clinic's figures are easier to read in this order:

• Flying home is possible from the day after surgery.
• Being able to fly does not mean you have recovered. The recovery period is about one week.
• Early swelling and bruising are possible and generally begin to ease after 3 to 7 days, depending on your constitution and the extent of surgery.
• Stitches come out on day 5.

In the first days you may also notice stiffness, pulling, a feeling of pressure or changes in sensation. During the operation, anesthesia reduces pain. Afterwards, prescribed pain relief is taken if needed. Swelling can make the area under the chin look fuller at first, so the clinic advises following the recovery rather than judging from how things look straight after surgery.

For seven days after surgery, avoid alcohol, smoking, saunas and jjimjilbang (Korean bathhouses), and exercise that makes you sweat heavily. Do not massage or rub the area. After the muscle tightening, avoid sleeping face down and moving your jaw excessively in the early period. If you go home early, follow the same instructions in Taiwan. Detailed instructions are given once your surgery date is set.

If you leave before day 5, the clinic writes a doctor's note for stitch removal, and you can have the stitches taken out at a clinic or hospital in Taiwan. Before booking flights, it helps to settle:

• your arrival date in Korea and your return date, shared with the clinic when you first get in touch, so the surgery day and stitch removal can be planned around them
• whether the stitches will come out in Seoul on day 5 or in Taiwan with the doctor's note, and where in Taiwan you would go
• what you need to avoid after surgery and for how long, explained clearly before you leave
• how to contact the clinic once you are home

Possible side effects of the surgery include bleeding, infection, inflammation, bruising, swelling and changes in sensation. According to the clinic, a Taiwanese interpreter works on site, and questions and bookings can be made through LINE.

What this article does not decide

Everyone's amount of fat, muscle condition and pace of recovery are different. Whether surgery suits you, how it is done and which anesthesia is used are decided after a doctor's assessment. The figures here are the clinic's general guidance, and the instructions you receive after your own examination come first.

This article was prepared from Clair Plastic Surgery's published information on swan-neck surgery, Dr. Han's explanations on the clinic's own channels, and the clinic's answers to our questions about this operation. It is general information, not a diagnosis or a treatment recommendation for any individual.