Revision for contour of neck line - would shaving or partially reducing the submandibular salivary glands be an option? (Photos)

Question

I had a lower deep plane facelift and platysamaplasty two years ago. The plastic surgeon was considered one of the best. He was board certified, experienced and trained in only doing facial surgeries. I am not pleased with the contour of my neckline. There is a visable line appearing that does not appear as a natural result. The surgeon refused to do a revision stating that he had done an aggressive neck lift and that I had a short chin. I have gone to two other well known surgeons in NC. One felt I should leave it alone. Another was willing to do a revision of the neck with a chin implant, but it would cost around the price of another lower deep plane facelift. After my surgery, I read that some experienced surgeons shave or partially reduce the submandibular salivary glands to contour a bulging upper neck and sharpen the jawline. Would this be an option for me? I am looking for opinions and suggestions to give me a better profile if this is even feasible. I am submitting before and after photos. These were taken approximately three months after my surgery, but as of today, my profile has not changed.

Philip Wasicek, MD · Answer

Hello, 
Submandibular gland reduction and deep structural neck contouring (including the submandibular glands, anterior belly of the digastric muscle and subplatysmal fat) can have profound impact on someone's jawline and neck. It is frequently recommended when people want the most improvement in their jawline/neckline. 
This surgery is highly technical and many plastic surgeons do not perform it. There are risks associated with this surgery. 
I would recommend being evaluated in person by a board certified plastic surgeon who specializes in facelift surgery including deep (structural) neck work including submandibular gland reduction. 
Hope this helps.

Mert Demirel, MD · Answer

Submandibular gland reduction can be used in very selected neck lift cases, but it is not a routine or low-risk revision. The glands sit deep in the upper neck near important nerves, vessels, and salivary structures, so partial reduction should only be considered by a surgeon with specific experience in deep neck contouring.
A visible line or unnatural contour after a deep plane facelift and platysmaplasty is not always caused by the salivary glands. It may come from a short chin, hyoid position, digastric muscle fullness, scar tethering, platysma contour, skin redraping, or over-resection/uneven deep tissue removal.
A chin implant can sometimes improve the neck profile by adding support and making the cervicomental angle look sharper. In a short chin, this may be safer and more predictable than trying to remove deep neck structures.
If the glands are truly prominent, shaving or partial reduction may help the upper neck contour, but it carries risks such as bleeding, dry mouth, salivary leak, nerve injury, numbness, asymmetry, and contour irregularity. It should not be done just because the neck line is not ideal.
My advice would be to get an opinion from a revision face and neck surgeon who performs deep neck work regularly. Ask them to identify exactly what structure is creating the line: gland, digastric, platysma, scar, skin, or chin deficiency. The revision plan should be based on anatomy, not simply on whether gland reduction is technically possible.

Zoran Potparic, MD · Answer

Based on these, less than perfect photos, you need revision surgery. Whether that can be done only using under the chin incision or a full face lift approach can be decided only on the basis of in person evaluation. Submandibular glands do not seem to be major problem but intraoperative findings may suggest opposite and require partial removal. Chin augmentation with implant would benefit overall result. I hope this helps.

Revision for contour of neck line - would shaving or partially reducing the submandibular salivary glands be an option? (Photos)

Answers (3)

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