My deep plane neck lift has failed. Can the submandibular gland be removed to get a better result? (Photo)

Question

I’m 36 and weight is 9 and half stone I had a deep plane neck lift it’s been about a month and it looks like it’s failed there is no different of the befoe and after I thought it looked ok when the bandages came off. Is this lax skin under my jawline or fat or my gland. He said hd got rid of fat loose skin and part of submadular gland after going through such a major procedure as a deep plane neck lift to look no different. Can the submadular gland be removed completely to get better result.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

To start with, I would say it is too early to conclude about your result. If your surgeon has carried out a deep plane neck lift, the work under the platysma leads to substantial swelling which unfortunately can take some months to settle down.

The end result will appear improved compared to the appearance at one month from surgery and I  suspect you will be pleasantly surprised .

Unlike surgical interventions for the neck that rely on tension, the surgery that reduces volume is associated with an interval of recovery and shows its full benefits later on. The outcome is also longer lasting as the sub-platysma structures have relatively stable shape over time.

I suggest that you discuss your concerns with your surgeon and allow at least six months of recovery before you draw conclusions about the outcome of your treatment.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding a 36-year-old man with neck laxity, particularly noticeable when looking down, and seeking advice on available treatment options. Your provided history and pictures have been helpful in assessing your situation. Most plastic surgeons would concur that you have three primary options:
Neck Lift: Given your skin laxity, a neck lift would be highly beneficial. The size and position of your larynx will not affect the results of a neck lift. This procedure can be combined with a facelift for enhanced results.
VASER Neck Liposuction: Many surgeons would also suggest considering VASER neck liposuction. The VASER technique is advantageous as it melts fat and heats the skin for maximal skin contraction, providing excellent results even in cases of loose neck skin. Post-procedure, it is crucial to wear a neck garment continuously for two weeks.
Morpheus 8 Treatment: If you prefer a non-surgical route, Morpheus 8 is a viable option. This treatment merges two technologies: microneedling for collagen synthesis and electrical stimulation for muscle contraction. These methods work synergistically to tighten the skin. Typically, three or more sessions of Morpheus 8 are recommended for optimal results.
In summary, while a neck lift is generally suggested for the best outcome, options like VASER neck liposuction and Morpheus 8 also present viable alternatives depending on your preferences.
I hope this answers your questions regarding the treatment options for a 36-year-old man with neck laxity.
Good luck.
Sincerely,
Dr. Katzen

Stephen Prendiville, MD · Answer

This is not a final result at 1 month; it is early in the healing process.  There is nothing to suggest "failure" at this juncture and there is no reason for anybody to suggest further surgery at this time.  Please follow up with your Surgeon and be patient

Jacob Tower, MD · Answer

Hello, hope you are doing well. Thanks for posting your question and photos. I think your jawline and neck contour look well-defined. It has been about a month since surgery, and at this point I would still expect some edema (swelling) in the neck. So, you may want to wait a few months before assessing your outcome and contemplating any further procedures. It is not obvious from the photos that you have gland hypertrophy or ptosis; my suggestion would be to wait a few months and then ask your surgeon to re-assess or seek another consultation. It would be a very rare occurrence to for someone to have their entire submandibular glands removed because it's not generally necessary, and could actually cause a skeletonized appearance. 
Best,Dr. Tower

Jeffrey H. Spiegel, MD · Answer

You can see if it's the gland by injecting the area with Botulinum (eg. Botox).  This will shrink the gland and get rid of that mass.  It could even be a permanent fix in some cases.

Connie Hiers, MD, FACS · Answer

First, you are really too young to get much improvement with a facelift, especially with a deep plane lift. Second, removing the gland may leave you with a dry mouth. Third, you might get good benefit with non or minimally invasive micro-needling with radiofrequency treatments like Morpheus or Secret, or even Renuvion.

Adam Hamawy, MD · Answer

Plastic surgeons possess several tools to address neck definition and facial aging comprehensively. Achieving the most natural and optimal results involves a strategic combination of these tools. 
 Even extensive deep plane facelifts only address certain structures such as the SMAS tissue and muscle but completely ignores deeper structures such as the bone and submandibular gland.

In your specific case, I would recommend a blend of multiple modalities to restore the structural integrity of your lower face, reinstating the definition that is presently lacking.  Structureal volumization to accentuate the angles of your jaw is probably all you need.  If necessary this can be supplemented with a suture suspension of the soft tissue of the neck including the submandibular gland although based on the photos above, that does not look like it is necessary.  Unlike the deep plane lift these procedures can be executed in an office setting within a span of approximately 30-60 minutes.

Thomas Spalla, MD · Answer

Based on what you've said, I assume you are seeking more jaw definition and a sharper transition between your jaw and neck. You noted that a portion of the gland was removed. The glands are beneficial for our baseline oral saliva production. While it's not harmful if they aren't present, they are beneficial.

The glands may not be solely responsible for what you are seeing. Sometimes, there is also contribution from the digastric musculature.

You could have Botox, or similar, injected into the gland. This can decrease its function and help to decrease its size as well. This could be a less risky alternative and may seek as a "trial" to better see what changes gland removal would have on you.

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