9 months post-op facelift - what exactly is wrong with my neck? (photos)

This type of problem cannot be solved with a gland pexy…years ago been there, done that with minimal change. Some people take out partial gland through a submental incision but it has limited visibility and requires a muscle splitting incision which could result in visible deformity. All of the above I’m referring to the standard SMAS, platysmaplasty approach. Your best approach is via a deep plane approach where gland exposure is better but still not the best. Also with this approach an incision of the muscle below the mandible border splits the flap in two vectors and allows the muscle to be tucked in. Also since the undersurface of the muscle is lifted with the nerve down, facial nerve injury is minimal.

It is very likely that major reason for current deformity are your large salivary glands. The only way to correct that would be partial removal glands, possibly trimming of digastric muscles to decrease the bulge. However, partial or total removal of the submandibular glands will decrease production of saliva and that may in time cause dry mouth. Reduction of glands is challenging procedure and you should seek second and third opinion of surgeons familiar with this procedure, to discuss pros and contras. Good luck.

There are several structures that can cause fullness in the neck- excess skin, subcutaneous fat, muscle, submandibular glands, and digastric muscles. As far as I can see, the prominent structures visible are a combination of submandibular gland and digastric muscle. In select cases, with those surgeons who are comfortable with this technique, those deeper structures can be partly removed (or suspended) to improve the fullness in this area.
Best,Dr. Perez

It is hard to tell from the photograph whether the fullness on either side of the anterior neck is caused by the submandibular glands or just residual fat and skin laxity, but this appears to be the submandibular glands. If you can feel a firm, rubbery, round nodule deep under the skin when you massage these areas that would be your submandibular glands. These can be partially removed with additional surgery but this is a very specialized procedure so you would need to find a surgeon with extensive experience in submandibular gland resection. The submandibular gland rest in a deep area of the neck and the surgical dissection into this area can be very vascular and hazardous. For this reason many surgeons do not perform this operation and it would be paramount that you find a highly experienced surgeon for this specialized procedure. On the other hand, if this fullness is just laxity of the skin or residual fat then additional fat removal and skin tightening procedures could be considered. In either case you need to discuss this with your surgeon first to determine the cause of the residual fullness and then a treatment plan can be created for you.