I had a suture suspension and liposuction done in November, 2010. but after 3 months I now have "hanging" submandibular glands that are pretty prominent. I have gone back to my surgeon and he has scheduled me for neck lift later this month which will include cutting off skin (from behind the ears), platysmal plication, and "basket" suture suspension of the glands. Based on the pictures attached, would these procedures help? Is the suture suspension of the glands dangerous?
Submandibular Glands - What Can I Do?
Doctor Answers (9)
Submandibular gland prolapse
This looks like a classic "cobra" deformity, with overzealous resection of the midline subcutaneous and subplatysmal fat. In conjunction with the above, there is some submandibular gland prolapse and digastric hypertrophy which was likely unmasked with agressive liposuction. This is a very difficult problem to treat. You can attempt to revise by performing a corset repair of the platysma and plicating the platysma over the submax glands, if that does not work then partial resection of the digastrics and partial submandibular gland resection may be warranted. There are only few surgeons who would be willing to undertake submandibular resection as the surgery is fraught with complications. Another option would be to perform structural fat grafting in the middle depression to camouflage the defect.
Fullness under the jawline may be due to more than submandibular glands
While submandibular glands can cause fullness under the jawline, I suspect the majority of your fullness is excess fat left between the skin and platysma muscle. The fat of this layer comes out easily right in the middle, and requires more effort/skill to debulk at the left and right side. This yields a result similar to yours.
I suggest you visit a surgeon who is VERY comfortable with neck surgery- you can be helped significantly.
Submaxillary gland prominence after surgery.
Submaxillary gland prominence after surgery is a problem, but I think you have more than that. You should wait at least 6-12 months before any more surgery and get a second opinion. What you have looks like platysma banding and thickening over the gland and much larger than the gland is.
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Although your submandibular glands are prolapsed and enlarged, this is only a part of the problem. The central mid-line concavity is known a cobra deformity, generally related to over-resection of submental fat and soft tissue. This can be corrected with a revision platysmaplasty combined with a collagen graft known as Enduragen. Submandibular gland prolapse is more difficult to treat because a neck-lift approach offers indirect access to the gland, and because of its proximity to a variety of sensitive structures (branches of the facial artery, vein, and marginal mandibular branch of the facial nerve). The gland can be temporarily reduced in size chemically with Botox or Dysport.
Is gland suspension during neck lift dangerous
The procedures seem appropriate as the picture seem to indicate excess fat of the neck as well. The platysmal plication may make the submandibular glands more prominent, not less. The submandibular glands can be suspended however, the dissection during this procedure does place the marginal mandibular nerve in danger of injury and for this reason, I do not perform this procedure.
Submandibular prominence after necklift and neck liposuction
I agree that it looks like the fullness you're experiencing is due to more than the submandibular glands. An examination would help determine this for sure. You are a bit earlier in the healing process and would benefit from more time to see what the final result is in the 6-12 month postoperative time frame.
PHOTO: Submandibular gland suspension and/or plication and/or resection
I would agree with Dr. Mayer, in that the area of fullness looks too extensive to be attributed to prominent of ptotic submandibular glands only. I am reluctant to manipulate these glands due to the proximity to vessels and nerves of concern. I also am aware of salivary fistulas and xerostomia (dry mouth) as undesireable consequences of salivary gland manipulation.
I have not found that reefing up the submandibular gland is helpful and resecting some of them can be dangerous with many complications. You need them for saliva production. I would leave them alone. As for the other issues you have to give it about a year to heal before retackling your neck.