Background <p>The lower face, particularly the neck contour, is an essential element of facial rejuvenation. One of the most effective tools for removing accumulating fat and redraping the neck skin is liposuction, requiring appropriate patient selection for the procedure.</p> Methods <p>This retrospective study included patients who underwent office-based neck USS-assisted liposuction under local anesthesia in 2023. This study aimed to measure patient satisfaction and pain during the procedure and the complications associated with the five steps of office-based neck ultrasound-assisted liposuction under local anesthesia.</p> Results <p>Of the 513 patients, 435 agreed to participate in our study, and 100% were female with a median age of 37.0 years. A total of 294 patients (67.6%) experienced mild pain, whereas 26 (5.98%) experienced severe pain. Satisfaction with the procedure was high, with 81.6% (n = 355) of patients expressing satisfaction, 14.5% (n = 63) reporting neutral opinions, and only 3.91% (n = 17) reporting dissatisfaction. Complications were infrequent, occurring in 3.45% of the patients (n = 15). Four patients had marginal mandibular nerve injury (0.91%) and all recovered. Fibrosis and asymmetry were reported in 3 cases (0.69%). Hyperpigmentation and hyperalgesia were reported by two patients (0.46%), while skin laxity was the least common, noted in one case (0.23%).</p> Conclusions <p>Choosing an appropriate patient for office-based neck ultrasound-assisted liposuction under local anesthesia can lead to excellent results and high patient satisfaction, with less pain and fewer complications.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>