Do submandibular glands permanently shrink after injections of Botox/Dysport or is ongoing treatment needed?

Question

1st necklift revealed bulging glands, 2 small hollows in lower neck that possibly resulted from excess fat removal. In revision, some issues w/1st lift were fixed. But now when lifting my head, glands are more pronounced, bulging down in chevron shape from jaw converging to a point under my chin, w/ hollows at center neck. A 3rd lift to reduce glands isn't appealing. If injected w/Botox, etc. does shrinking result last or require upkeep? What are risks? Am I a candidate?

Oxana Popescu, MD · Answer

Neck Lift Hello and thank you for the question and your photos.

The answer to your question is that repeated injections of Botox can cause salivary gland atrophy. It will take a while and repeated treatments to see results, and you may need maintenance. Oral mucosa dryness can occur as a side effect..
It is also possible that your areas of concern are actually due to residual pockets of fat and an "in office" evaluation would be extremely helpful.
Concluding: 
Botox only or a combination of Botox and Kybella for the excess of fat could improve the aspect of your neck line. 
Smart Lipo would permanently treat the band of loose skin under the chin, the residual fat pockets, and the visible crepey skin. It can be combined with Botox for an extremely well defined jaw line.

I hope this helps.

Best,

Oxana Popescu MD

Thomas Fiala, MD, FACS, FRCSC · Answer

Hi.  I'm not convinced either that this neck shape is related to descent of your submandibular gland, or the presence of a large gland.  It looks more like the V shaped contour of your digastric muscles on each side has been revealed by fat resection.  Some surgeons will reduce these during an open neck lift - but you will need to research someone who does a lot of secondary neck work.

Robert W. Sheffield, MD · Answer

By just looking at your pictures, the diagnosis cannot be 100% accurate. It seems that most of your fat was removed; however, it seems like your digastric muscles are the ones causing your concern, and removing the fat between them causes what is known as “cobra deformity.” In this case, Botox can relax those muscles and decrease their size but will not provide long term effects and is not the most effective option; the most effective treatment could be surgical instead. A full revision of the area should be made by a board-certified plastic surgeon to properly examine the area and choose an effective treatment for your concern.

Monika Soni, MD · Answer

Thank you for your question! I think you are on the right track that excess fat was removed during one of your facelift procedures. While it's difficult to see from your photos, I'm not convinced that the bulges are your submandibular glands. Rather I believe the bulges are more likely your digastric muscles, and when the fat between them is removed it creates a "cobra deformity". The best way to treat this is either by reducing the size of those muscles, suturing them together in the midline, or a combination of both. Botox will weaken those muscles causing them to relax and shrink a little, but it will not make the chevron bulge go away. I recommend you be evaluated by a facial plastic surgeon to get a better handle one what is exactly causing the bulging in your pictures, but I suspect Botox will not be a very effective treatment. Best of luck!

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs KittieW. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.While Botox is best known for its use in cosmetic treatments, there are many other indications for Botox including excessive sweating in the underarms, palms, and soles, migraine headaches, cervical dystonia, spasms of the eye muscles, cross eyes, and bladder dysfunction. It has also been shown to help with depression, premature ejaculation, abnormal heartbeats, cleft lips, and pain with intercourse for women.Botox can be used to reduce the size and appearance of the parotid and submandibular glands. similar to when used for cosmetic purposes patients will enjoy their results for three to four months, at which point a maintenance treatment is recommended.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Ronald J. Schroeder II, MD - Account Suspended · Answer

I think you are on the right track that excess fat was removed during one of your facelift procedures. While it's difficult to see from your photos, I'm not convinced that the bulges are your submandibular glands. Rather I believe the bulges are more likely your digastric muscles, and when the fat between them is removed it creates a "cobra deformity". The best way to treat this is either by reducing the size of those muscles, suturing them together in the midline, or a combination of both. Botox will weaken those muscles causing them to relax and shrink a little, but it will not make the chevron bulge go away. I recommend you be evaluated by a facial plastic surgeon to get a better handle one what is exactly causing the bulging in your pictures, but I suspect Botox will not be a very effective treatment.

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