Summary

The elements that characterize a youthful neck include a distinct inferior mandibular border, visible sub-hyoid depression, noticeable thyroid cartilage bulge, visible anterior sternocleidomastoid line, and 90_ angle with the submental line and cervical mental angle of 105 to 120. These criteria are seen in the glamour model. Unfortunately, as we collect birthdays, we also tend to gain a bit of weight, and sometimes fat begins to accumulate in the under the chin region.  Storing fat in the neck region can also be genetic (thanks, Mom and Dad).  When treating the neck, the goals are often the restoration of a slender neckline, a well-defined neck to chin angle, treatment of the vertical bands that can form, reduction of neck fullness due to fatty tissue, and wrinkle control. Neck liposuction creates a firmer, smoother, and more refined appearance to the neck and chin and helps restore balance to facial features by providing a better-defined jawline that frames the rest of the face.

As we age, the relatively thin skin of the neck region loses its elasticity and starts to sag. Unfortunately, as we collect birthdays, we also tend to gain weight, and sometimes fat accumulates under the chin region.  Storing fat in the neck region can also be genetic (thanks, Mom and Dad).  The most superficial muscle in the neck region is called the platysma muscle, and as this loosens with time, vertical bands along the Neck may form.  Wrinkles may form, especially if we forget always to use our sunblock.

The goals when treating the Neck are often the restoration of a well-defined neck to chin angle, treatment of the vertical bands that can form, reduction of neck fullness due to fatty tissue, and wrinkle control. There are several choices for the treatment of the Neck that depend on your anatomy and your desires.  These alternatives can include face lifting, neck lifting, Neck Liposuction, and other modalities.  A slender neckline is recognized as an attractive feature of youth.

Neck liposuction creates a firmer, smoother, and more refined appearance to the neck and chin. Even without making any other changes to the face, improving a thick, wrinkled, or sagging Neck can dramatically improve one’s appearance, helping patients look years younger or even as though they have lost weight. Neck liposuction can also help restore balance to facial features by providing a better-defined jawline that frames the rest of the face.

What are My Neck Liposuction Options?

Neck liposuction isn’t defined by a surgical technique but rather the patient’s aesthetic goals. A cosmetic surgeon will use a completely different surgical approach for a patient who wants to reshape a full chin versus a patient who wants to eliminate a sagging “turkey neck.” Neck liposuction can be performed as a single procedure or be combined with other facial cosmetic surgery procedures for more comprehensive improvements. Inappropriately selected patients, Liposuction of the Neck using tumescent local anesthesia can effectively render a more-youthful, slimmer appearance with a minimal amount of downtime.

Nek Liposuction exerts its effect via a combination of subcutaneous fat removal and release of skin–muscle attachments. Release of the skin from underlying platysma muscle allows for avid skin contraction in young and middle-aged patients. In such patients, the technique is straightforward, and I should obtain uniformly excellent results.

Ideal candidates for Liposuction of the Neck are patients with isolated fat deposits with good skin tone and minimal platysma laxity. Liposuction of the Neck is safe for most women and men with a double chin and loose, sagging skin. Tightening and retraction of the skin can be dramatic with tumescent Liposuction alone. The procedure is well tolerated and uncomplicated and gives long-lasting results. Some patients may require additional procedures if this isolated technique is not entirely effective. I can further enhance the result in patients with sagittal microgenia with the addition of a genioplasty. Correction of the skeletal deficiency combined with sub-mental Neck Liposuction can yield a dramatic result.

Liposuction of the Neck is undertaken using ultrasound power-assisted Neck Liposuction (U-PAL) with the tumescent technique. I can extend the operation to treat patients with markedly fat necks or patients with mild or moderate skin excess. In such patients, sub-mental and post-auricular approaches are used to minimize skin contour abnormalities. Wider skin undermining should also be practiced maximizing skin contraction.  While not ideal patients, this group will demonstrate significant improvement.

The use of UAL carries the potential risk of thermal injury, dysesthesias, and marginal mandibular nerve palsy. UAL has, therefore, not been widely adopted in the submental region because of its increased potential for complications, complex and bulky instrumentation, and additional cost.

Newer technologies include VASER (vibration amplification of sound energy at resonance), and SmartLipo are theoretically a safer and more efficient process than standard ultrasonic Neck Liposuction. However, higher concentrations of free fatty acids after laser-assisted lipoplasty may cause possible hepatic and renal toxicity.

What is External Ultrasound-assisted Neck Liposuction (EUAL)?

After introducing internal ultrasonic-assisted Neck Liposuction (UAL), reports of a higher incidence of complications such as skin necrosis and seromas tempered patients and physician enthusiasm for internal UAL. The consequence has been a new interest in testing the application of external ultrasound before Neck Liposuction.

Although external ultrasound has been used in the clinical setting to enhance post-traumatic and postoperative healing, external ultrasound pre-operative for Neck Liposuction is a relatively new concept. The application of external ultrasound before Neck Liposuction is a technique that requires transcutaneous application of high-frequency ultrasonic fields delivered into wet tissue, followed by traditional aspirates Neck Liposuction, to improve the mechanical removal of the fatty cell.

External UAL, during which the ultrasonic energy is applied through the skin, must be differentiated from internal UAL, during which the ultrasonic energy is applied through a specialized cannula. Recently, external UAL at frequencies of 2-3 MHz and a potency of 3 W has been associated with complete fat tissue disruption, including adipose cells and collagen networks.

This new technique reported to soften or disrupt adipose tissue and (1) facilitate the task of suctioning adipose tissue and increase the amount of fat extracted (2) make the patient more comfortable during and after the procedure, and (3) improve the quality of the aspirate by decreasing the amount of blood(4) it allows superior access through scar tissue(fibrous); and (5) it is not constrained by internal structures and can, therefore, be used to treat larger areas.

Ultrasound causes tissue destruction via three mechanisms: (1) cavitation, (2) micromechanical disruption, and (3) thermal damage. Ultrasound reports suggest that the disruptive biologic effects of external ultrasound are due to micromechanical disruption or tissue heating. Other reports postulate that external UAL loosens adipose cell attachments, facilitating aspiration. It disrupts membranes and affects calcium influx, which can stimulate mast cell degranulation.

Ultrasound can induce fibroblast activity and enhance collagen production. It can stimulate endothelial cell activity and new capillary formation in chronically ischemic tissue. These effects make ultrasound useful for the care of chronic wounds, as well. In addition, the manifestations of effects of external ultrasound appear to be directly proportional to the intensity delivered, with simple cellular detachment at 1 MHz to complete adipose cellular destruction at 2-3 MHz.

What is Power-Assisted Neck Liposuction?

Almost all types of energy have been combined with Neck Liposuction to improve patient experience and results. The “power” in power-assisted/power-tumescent Neck Liposuction uses a tiny mechanical tube (cannula) that efficiently removes fatty tissue. The mechanical vibrations produced by the power unit are soothing and may decrease procedure time. Powered Neck Liposuction can increase fat extraction by 30% or more over non-powered Neck Liposuction. Patients love the vibration sensation of powered Neck Liposuction or traditional non-powered Neck Liposuction.

Prof. Moawad was the first to use this technique in the Middle East 15 years ago. In power-assisted Neck Liposuction, a cannula with a back-and-forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort. Studies that compared power-assisted to traditional Neck Liposuction found that power-assisted Neck Liposuction was superior in the ease and speed of fat extraction, faster healing and recovery time for patients, shorter procedure times with less surgeon fatigue, and lower incidence of the secondary touch-up procedure. Appropriate tissue accommodation or retraction occurred after Neck Liposuction in most treated sites, except in areas that exhibited a significant degree of tissue laxity preoperatively.  The short-powered strokes can be used more precisely than the longer “to and fro” motion of manual Neck Liposuction. The devices can also be used while holding the hand still to remove fat in difficult areas such as the peri-umbilical region.

Your consultation with Prof Moawad

During the consultation, Prof. Moawad will review your medical history, evaluate your present health, and assess the current condition of your skin, considering elasticity as well as localized fat deposition. Your current weight, and whether you plan to lose or gain, will factor into this evaluation, along with what effects, if any, initial weight-loss had on the areas of your body you want contoured.

I will address your expectations as to whether they can be realistically achieved, in addition to which body Neck Liposuction method and procedure technique will be most suitable in your case. Prof. Moawad will discuss how factors like the general state of your health, overall condition of your skin, your weight, age, hormonal influences, and certain other factors, can all influence the outcome of your procedure.

Instructions for High Definition Neck Liposuction

Preoperative instructions

• DO NOT SMOKE for two weeks before and two weeks after surgery. Smoking reduces blood circulation, slows down healing, and increases complications.
• DO NOT TAKE ASPIRIN or products containing aspirin or anti-inflammatories such as Brufen, Cataflam, and Ponstan for two weeks before or following your scheduled surgery. These medications affect your blood’s ability to clot and increase your tendency to bleed during surgery or the postoperative period. If you need to take a mild painkiller, you can take paracetamol.
• DO NOT TAKE DIETARY SUPPLEMENTS for two weeks before and after surgery. These include vitamins, ginger, ginkgo Biloba, garlic, ginseng, and fish oils. They may increase your risk of bleeding and bruising during and following surgery.
• DO NOT DRINK ALCOHOL for five days before surgery. Alcohol may increase your risk of complications as well as bruising.
• IF YOU DEVELOP A COLD, COLD SORE, FEVER, OR ANY OTHER ILLNESS BEFORE SURGERY, PLEASE NOTIFY US.
• DAY before AND DAY OF SURGERY: Please shower using only anti-bacterial soap. Males receiving abdominal or flank treatment may prefer to shave the treatment area; women receiving abdominal or thigh treatment may prefer to shave pubic areas below the hairline.
• WEAR COMFORTABLE, DARK, LOOSE-FITTING CLOTHING: on the day of surgery, including a shirt that buttons up the front. Wear nothing that you must put on over your head. Slip-on shoes are recommended for most postoperative comfort. We suggest you safeguard your car seat and bedding with a protective cover as there will be some fluid leakage following surgery.
• LEAVE JEWELRY AND VALUABLES AT HOME. Do not wear wigs, hairpins, or hairpieces.
• AVOID WEARING MAKEUP, FACIAL OR BODY MOISTURIZERS.
• SURGERY TIMES ARE ESTIMATES ONLY. You could be at the clinic longer than indicated.
• ARRANGE FOR A DRIVER TO AND FROM SURGERY. We cannot discharge you to a taxi. Put a pillow and blanket in the car for the trip home.
• HAVE A LIGHT BREAKFAST on the morning of surgery.

Postoperative Instruction of High Definition Neck Liposuction

• It is essential to instruct patients to stay in a sitting position for at least 4 hours after the procedure to prevent tumescent fluid from being absorbed in deeper areas. Whenever possible, the amount of tumescent fluid should be limited to 500 to 700 mL to prevent Globus pharyngeus.
• IF YOU EXPERIENCE EXCESSIVE PAIN OR BLEEDING, FULLNESS OR SPREADING REDNESS IN TREATMENT AREAS, OR FEVER, PLEASE CALL US IMMEDIATELY
• DRIVING: A family member or friend must drive you home from your surgery (it is best to have them stay and help you for the first 24–48 h). Please do not drive if you are taking prescription pain medication.
• COMPRESSION GARMENTS: If you had liposuction performed on your knees, thighs, hips, arms, or abdomen, I put on a particular elastic-type garment at the end of surgery to give comfort and support while helping your skin conform to your new body contour. The day following surgery, you may remove the garment once a day for laundering, sponge bathing, and bandage changing (if present). Continue wearing the garment 24 h a day for the first two weeks, followed by 12 h a day (remove at night) for the following two weeks.
• BATHING OR SHOWERING: Sponge baths only for the first 72 h when removing the compression garment. After 72 h, you may take a shower or bath when the garment has been temporarily removed. Avoid Whirl Pools and hot tubs for at least one week (until the incision sites have healed).
• TREATMENT SITES: Please keep your dressings as clean and dry as possible, changing daily if wet to help prevent infection. Do not apply heat or ice to the surgical areas. You should expect significant drainage (oozing) of blood-tinged anesthetic solution at the incision sites due to fluids injected during your procedure. Although the fluid may seem red, it comprises almost all of the anesthetic solution injected during the procedure and only 1% blood. In general, the more drainage there is, the less bruising and swelling there will be. Many patients have found it helpful to use a shower curtain or other protective covering on their mattress for the first few days after their liposuction procedure. When your incisions stop draining, please clean with tap water and apply petroleum jelly to the incisions. Itching, pulling, pinching, hardness, tightness, and/or numbness sensations are normal. All should subside within 24 h to 1 week but sometimes can last for months. This is part of the healing process, and your patience is appreciated.
• ACTIVITY: Rest for the first 12 h. It is normal to experience light-headedness when rising or removing/changing your compression garments. Please have someone help you with this for the first few days after surgery. Take it easy for the first week, resuming regular activity as tolerated. You were experiencing more than mild swelling, and discomfort may show that you are overdoing it. Avoid strenuous activities, lifting over 10 Ibis, or aerobic exercise for 2–3 weeks. Protect incisions and any bruised areas from the sun until wholly healed; use SPF30 or greater for six months. Avoid tanning until skin bruises have faded, which generally takes 10–14 days. If you like, feel free to treat yourself to a gentle massage during your postoperative course. Therapeutic massage is beneficial to speed the healing process. It may be done beginning two weeks after surgery, as often as every second day, and as hard as you can tolerate.
• DIET: If you experience any postoperative nausea, try carbonated drinks and dry crackers to settle your stomach. Take your postoperative medications with food to reduce irritation. If your stomach feels normal, start slowly with liquids and bland foods, progressing to soups, and finally, a regular diet as tolerated. Drink plenty of clear fluids.
• ALCOHOL: As well as/In addition to refraining from drinking alcohol for at least five days before surgery, it is imperative that you do not consume alcohol if you are taking over-the-counter or prescription pain medication following surgery as they may interact.
• SMOKING: We continue to stress the importance of not smoking. Smoking reduces blood circulation to skin and tissues and delays healing. Do not smoke at all during the first 14 days after the procedure.
• EXPECTATIONS: Remember, the goal of fat removal is not weight loss but for improved contour. Since the body retains fluids in response to surgery, you may notice a temporary weight gain, resolving over the first week. In addition, remember that for most people, the goal is a significant improvement, not perfection. Lower abdominal patients may experience significant swelling in the pubic area. Postoperative discomfort usually takes the form of deep muscle soreness and usually improves over the following 2–7 days. Slight temperature elevation and flushing of the face, neck and upper chest could last 48 h. You may initially experience a mild depression that should begin lifting after the first week once you see the bruising and swelling fade. Menstrual irregularities (premature or delayed monthly onset) are a common side effect of surgery. If I treat treated areas on the thighs, you may have swelling in your calves and ankles for up to 3 weeks.
• POSTOPERATIVE MEDICATIONS. Please take the antibiotics and pain medicines as advised or prescribed by your doctor. If you have no allergies, you may start with regular paracetamol (1,000 mg every six h). If this does not relieve discomfort or pain, you can take the prescription pain medication in addition to the paracetamol. Do not take aspirin, Brufen, or Neurofen. If antibiotics are prescribed, you must complete the entire course.
• POSTOPERATIVE APPOINTMENTS. For most healing and optimal long-term results, you must follow the appointment schedule that is made following your surgery.

What are the Risks Involved in High Definition Neck Liposuction?

Neck Liposuction performed under general anesthesia with hospital admission carries a higher risk of serious adverse events. This form of Neck Liposuction, referred to by some authors as “traditional” or “conventional,” Tumescent Neck Liposuction is a safe procedure on the condition that patients are carefully selected. The operating facility is adequately equipped, and the physician is adequately trained in the procedure.

How do I Prepare for High Definition Neck Liposuction?

You are provided with specific preoperative instructions. I will take preoperative photographs, which are essential aids in planning and performing the procedure, due in part to the patient being in a horizontal position during the procedure. Postoperative photographs are taken at 3- and 6-months post-surgery (body photographs are faceless). If you smoke, you are advised to stop two weeks before your procedure. Smoking can affect the operation and impede healthy healing.

Additionally, you must alert your medical staff to any medication you are taking; certain drugs like aspirin, non-steroidal anti-inflammatory, and Vitamin E may increase bleeding during and after the operation. In addition, some medications, e.g., antibiotics, may interact with the local anesthesia. It is generally advised to stop eating and drinking at least 6 hours before the procedure. Pending your circumstances, you may want to arrange for someone to drive you home following your surgery, as well as to help you at home for a day or two.  It is recommended you reschedule your procedure should you develop a cold or an infection of any kind, especially a skin infection,  during your menstruation.

Will High Definition Neck Liposuction Incisions be Apparent?  Will I Have Scars?

A tiny incision (2mm) is all that is required for the insertion of the tube. Incisions are generally tiny, about ¼ inch. At MSI, our method of re-Neck Liposuction leaves minimal scars, and Prof. Moawad strategically places incisions within the natural folds of the body.

How long Does it take to do High Definition Neck Liposuction? Can I do other Areas?

The duration of the operation lasts anywhere from thirty minutes to two hours, sometimes more depending on how many areas are treated. And, although much can do multiple areas simultaneously, Prof Moawad prefers to do one site at a time to ensure the patient’s safety and rapid recovery. Extensive deformities affecting several body areas can be planned and done in several stages (sessions), allowing for a shorter healing period and a more reliable, rapid recovery.

Where will the High Definition Neck Liposuction be Performed?

Neck Liposuction is performed at MSI as an outpatient/ in-office procedure for rost, convenience, and comfort. Reasons It’s now a well-known fact that in-office liposuction is safer than traditional Neck Liposuction done within a hospital setting.

Is the High Definition Neck Liposuction Painful? Will I be Awake?

The principal factors in determining the type of Neck Liposuction and kind of anesthesia patients should have, such as, straight tumescent method, sedation standby or sedation, are pain tolerance, the amount of fat to be removed, and the patient’s past and current medical health conditions; all factors considered when selecting the anesthesia that will give the safest, most effective level of comfort during your procedure.

If only a tiny amount of fat and a limited number of body sites are involved, Neck Liposuction can be performed under local anesthesia, which numbs only concerned areas. The local is usually used along with intravenous sedation to keep you more relaxed during the procedure. Some patients enjoy being awake during the procedure, and Prof Moawad refers his patients to be awake into the best position during liposuction with the patient coöperation.

What is the Technique for High Definition Neck Liposuction?

Neck Liposuction of the neck can be performed readily under local or general anesthesia. The patient is marked in the sitting position before surgery, noting the submental and/or submandibular fat location and the extent of tunneling to be performed. A large volume (50 ccs) of 0.5% and 1: 2 000 000 epinephrine is injected through the submental and postauricular approach. For most vasoconstriction effects, 15 min is allowed to elapse.

A small caliber (2.4-mm) suction cannula with single or multiple holes is used. Holes are directed toward the soft tissue; Neck Liposuction is begun through the submental incision using wall suction fanning out from the submental incision. Additional postauricular stab incisions can be used to cross-Neck Liposuction. Relatively little fat is generally removed, and overly aggressive Neck Liposuction is to be avoided to decrease postoperative adverse sequelae such as contour irregularities, banding, and skeletonization of the neck. Less is generally more with this procedure. Commonly, little change is seen on the operating table. No drains are used. An elastic garment is worn for five days postoperatively and two weeks at night only.

What Can I Expect Immediately after High Definition Neck Liposuction?

Though tumescent Neck Liposuction is more refined, you may still experience some pain, burning, swelling, ecchymosis, and temporary numbness. With the tumescent technique, postoperative discomfort is much reduced since the local anesthesia remains in the treated tissue, usually causing numbness for sixteen hours or more after surgery. If required, Extra Strength Tylenol or Tylenol with Codeine is enough to control relatively minor discomfort that may occur following your surgery.

• Immediately after surgery, you are transferred to our luxurious recovery room, where you are fitted with a support garment that you are required to wear continuously for two to four weeks (if If I treat treated calves and/or ankles, you would need to wear a support hose for up to six weeks).
• Generally, after the procedure, you will probably have some fluid drainage from the incisions and can expect some bruising and swelling (bruising generally goes away in 3 weeks; swelling can last for three months depending on the amount of work done).
• Most patients can walk out of the office without help. Recovery time will vary greatly depending on the person, how extensive the procedure, and the technique used.

How Will I look During My Recovery?

• You may remove the garment to shower the day after surgery. You may feel stiff and sore for the first few days after your procedure, but you are encouraged to move about, even a little since this will aid in blood circulation. Dressings will be removed in several days, so Prof. Moawad and his staff can check treated areas.
• You will be scheduled for follow-up visits to check your progress and receive an ultrasound massage, lymphatic drainage the day following your surgery, then every other day for the first week.
• Subsequent follow-up visits are scheduled at one month, then again at 3- and 6-months following surgery. If you have any unusual symptoms between visits, such as heavy bleeding or a sudden increase in pain, or any questions about what you can and cannot do, you are advised to call MSI immediately.
• For the most part, the results of Neck Liposuction can be dramatic. Saddlebags may disappear. Legs and hips become thinner and shapelier. Stomachs become flatter and firmer, and double chins can be sucked away.
• Occasionally the skin may have an uneven or slightly rippled effect. The surface can sometimes be irregular or asymmetric, or pigmentation changes may occur, especially in older patients with dark skin. If you have skin dimpling (cellulite), it will still be there following your surgery.
• Scars from Neck Liposuction are usually minimal and strategically placed within body folds. Overweight patients who have localized areas of fat removed must be willing to accept a greater chance of contour irregularities and less than ideal skin re-draping in exchange for improving the way they look in clothing.
• At MSI, we are proud to be the first center in Egypt that post-Neck Liposuction particular skin tightening program. It involves vacuüm, soft laser, and photodynamic therapy using LED technology. The treatment session will speed the recovery time and make sure to have tight skin. Further tightening effect can be achieved only at MSI using the FDA-approved monopolar radiofrequency device for nonsurgical skin lifts.
• You should avoid strenuous activity for about three weeks. Patients may return to work in one week, although many return earlier. You are advised not to take aspirin or certain anti-inflammatory drugs and not to smoke.

Are Results of High Definition Neck Liposuction Permanent? Can Fat Return?

On the condition, you stay at your postoperative weight, and a proper diet and exercise become part of your routine, the results of Neck Liposuction will be permanent since there are now fewer fat cells in those areas that were contoured.  Weight gain is the natural enlargement of existing fat cells, not the creation of new ones. The more significant fat cells there in a specific place, the more difficult it is to cut in that area simply by dieting. Dieting usually reduces the size of all fat cells proportionately but essentially leaves the basic silhouette unchanged. Should you gain a few kilos, the weight will be more evenly distributed and not accumulating in the same problem areas before the procedure. Doctors believe that once Neck Liposuction has removed fat cells, these same cells do not return.

Will My Skin Hang after High Definition Neck Liposuction?

Prof. Moawad’s initial assessment determines the amount of fat removed during the consultation, ensuring that your skin re-drapes appropriately. The degree of skin change after Neck Liposuction surgery is the same as one would expect if it were possible to lose an equal amount of fat in these localized areas simply by dieting. Because the small cannulas make small tunnels through the fat, multiple connections remain between the skin and the underlying tissue. These fibrous connections contract with the healing process and keep up the skin in its natural place. After Neck Liposuction by tumescent Neck Liposuction, one does not have to worry about excessive skin folds in the areas treated by Neck Liposuction surgery. This effect is so dramatic that many patients who previously required surgical excision of skin called a tummy tuck can now have excellent results simply by having power-assisted Neck Liposuction. Radiofrequency nonsurgical skin tightening can be achieved only at MSI using the FDA-approved monopolar radiofrequency device for nonsurgical skin lifts. Only those with lax musculature and very loose skin with or without excess fat might need more procedures like face and neck lift or abdominoplasty (tummy tuck) or thigh lift.

Will I Need a Second Procedure? If So, When?

Most patients need just one procedure. Less than ten percent of patients need a fine-tuning procedure after six months.

Combining Neck  Rejuvenation and Facial Rejuvenation Procedures

• As the face, eyes, and neck work together to create a person’s facial appearance, combining face and neck procedures is common to achieve a patient’s goals. Doing so helps to ensure smooth, refined lines and a naturally balanced appearance. Below are some of the standard procedures that patients choose to accompany their neck contouring surgery:
• A cosmetic surgeon will rarely perform a facelift without incorporating some neck contouring element. Combining a facelift and neck lift allows a cosmetic surgeon to address jowls, sagging cheeks, and lax neck tissues in a single procedure.
• Chin augmentation. A skilled, qualified cosmetic surgeon can insert a custom-fit chin implant during a neck liposuction procedure, typically using the same incisions, to refine the neckline and add definition to a weak or receding chin.
• Balanced proportions are critical to an attractive face. Reshaping the nose to fit a patient’s face better while also improving the jawline can dramatically enhance this sense of balance.