Hanging Glands, Jowling. What Do I Treat First? (photo)

Do you ever perform procedures to correct/minimize large submandibular glands? Can botox shrink them down? As my skin ages, this area has begun to hang in an uncomfortable, unattractive way. The glands are tender and firm and I don't know if they have grown or just descended plus some beginning joweling and deep nasolabial creases. And major neck banding! I'm only 38! I don't smoke. I'm lean and athletic and my face doesn't match my body anymore. I'm overwhelmed: what to treat first?

Doctor Answers 6

Take A Deep Breath.

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Dear Peabelly

I agree with the other doc, your neck ain't bad, it is just not as grand as it once was.  The important thing here is to avoid haste and don't talk yourself into having surgery in a panic.  This is how people make mistakes they come to regret for a very long time.  Because of your concerns, it is reasonable to consider getting some consultations.  You should have a list of concerns and what you would accomplish if you had a magic wand.  You want to carefully listen to what the cosmetic surgeon has to say.  Try not to fall in love immediately, avoid coercive office that what you to make a decision on the spot (i.e. "what you make you sign up for surgery today?").  See more than one type of specialist offering cosmetic services.  This will expose you to different thinking about improving your overall appearance.  Consider posting again to share what you have learned.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Hanging submadibular glands or jowls, which to treat first?

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It is difficult to tell the extent of your descending submandibular glands from the photos. They would have to be assessed in person by a plastic surgeon. If they are too low the lower portion of the gland can be resected. "Tacking" them up does not work. Resecting them requires an incision in the submental region and should be done as a last measure.

I can tell that you have platysma bands and this could be treated by a simple procedure, according to their extent. If you also want to tighten the skin, this would be more extensive and would essentually some degree of a facelift.

If the loose skin is the main problem and you want to do the least invasive procedure, there are lasers (Fraxel) that tighten the skin somewhat, and you may have lost volume in your face causing some of the jowling. These can be addressed through non-surgical measures.

I suggest making an appointment to see a PS that you trust to discuss your problem and the remedies.

Good luck

Hanging Glands, Jowling. What Do I Treat First?

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 Aesthetically speaking, I see some loose skin and anterior muscle bands but not enlarged submandibulatr glands.  Perhaps these are palpable in person and this would indicate an in person consultation is required.  Ptotic or low submandibular glands can be re-supended but this is rarely donme and does place the marginal mandibular branch, of the facial nerve, in jeopardy.  

 Some form of a Face Lift would seem to be indicated at this time if you wish to reduce the appearance of the jowling.  The most common version, of a Face Lift, that we perform is the minimal incision Face Lift (Celebrity Face Lift) that has smaller incisions with a very rapid recovery.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Aging Changes

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Based on the photograph provided, I do not see any aesthetic concerns regarding your submandibular glands. Since submandibular glands secrete a combination of thin serous and thick mucinous saliva, Botox is not commonly used to shrink them due to the risk of gland inflammation related to mucinous sludging. This could potentially worsen the tenderness you are currently experiencing. What is evident in the photographs is mild cervical obliquity related to skin and platysma laxity, combined with mild jowls and deep nasolabial folds.  Based on these findings, which would require confirmation with an in person consultation, Ultherapy could provide some benefit for the jawline neck area; Ultherapy utilizes focused Ultrasound waves to heat the deeper tissues, stimulate collagen production, and tighten the lower facial soft tissues.  A filler such as Radiesse, Juvederm, or Restylane could help soften the nasolabial folds.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

I Would Take It One Step at a Time

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It is hard to give you exact answers to all of your questions but I do believe I will have some helpful but I think I will have some helpful answers for you.  You did not age overnight, so you should not feel the need to correct everything overnight.   You are still young so you will have many surgical and non-surgical options.  If you where my patient, I would want to know you top 2 or three concerns on work on those issues.  Your issues and possible treatments:


Large submandibular glands-  If they are tender, you may a low lying infection or other process.  I would see an ENT for a medical evaluation.  They are not that enlarged in your picture.


I would focus on trying to use botox and fillers to help you age gracefully at this age.



Early Neck Aging Options

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I do not appreciate any submandibular gland ptosis in your photos. You do have some early signs of neck and jowl aging. You may benefit by some standard techniques to address the loose skin and the prominent cervical band. Whether they are worthy of that effort now or are best done later as they become progressive is a matter for discussion with a plastic surgeon during an actual consultation. There are a variety of options, some even non-surgical, that mahy be considered in this discussion. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.