Facelift: is a submandibular gland reduction safe?

Thank you for your answer. A (partial) submandibular gland resection is sometimes performed to support a saggy submandibular gland during a face and necklift operation. It is rarely done on its own. During a necklift, the exposure to the submandibular gland is extremely limited, and few surgeons perform this surgery routinely. Before I re-trained in plastic surgery, I was a board certified otolaryngologist (ear, nose and throat), the specialty that most frequently removes these glands for cancerous reasons. I can tell you that even with the wide exposure of an external incision under the jaw, it is not an easy surgery. Not dangerous, but not easy. The marginal mandibular nerve, which allows you to frown, runs on the surface of the gland. It also bleeds easily. I would say it would take a very brave, and/or skilled surgeon to approach the submandibular gland from a submental incision (and probably both). The number of facelifts I have performed numbers in the thousands, and resecting a submandibular gland is not something I take lightly. Fortunately, you would notice a tremendous improvement with or without gland excision from a face and necklift.

The volume excess under the jawline is typically a combination of fatty tissue, anterior belly of the digastric muscles and lower part of the submandibular glands.
Depending on the degree of correction that would like to achieve, all these components can be addressed and the track record for this surgery is very good. It does require a surgeon who is experienced in working on these structures.
More specifically for the submandibular glands, their volume tends to take away the lateral definition of the jawline. The definition is fundamentally based on having enough of a step between the contour of the jaw in the contour of the neck to produce a shadow. In a facelift procedure, the tissues are tightened and the contour of the soft tissues of the jaw is lifted slightly, exposing the submandibular glands slightly more.
There are differences of opinion between surgeons regarding the value of this operation, but patients that had the treatment in hands of experienced surgeons seem to appreciate the benefits.

Hi weewers,

In the hands of an experienced surgeon, this procedure should be safe. There are always risks and complications to any surgical procedure. This part of a neck rejuvenation procedure takes more time and should be done by a surgeon who is familiar with the anatomy in the area.

In your case, I think that you have fat in the neck area that is definitely contributing to the heavy look that you have in this location. Please see an experienced plastic surgeon in your area who can give you an in person exam and explain to you your best options.

Best Wishes,

Dr. Christine Rodgers

When evaluating the jawline and neck, the presence of neck laxity, platysmal banding, submental fat, as well as the presence of submandibular gland prominence is analyzed. It is not common to perform a submandibular gland reduction during a face lift, but in certain cases it may improve the contour of the jawline and neck. The procedure does involve more risk, including risk to the nerve that controls movement of your lower lip, and risk to blood vessels that are near the gland. If deemed appropriate for you, an experienced surgeon who performs these commonly should perform the surgery. Whether submandibular gland resection or is an ideal addition to your neck rejuvenation procedure requires an in person examination by an experienced surgeon familiar with and comfortable with that specific anatomy. Best wishes.

Removing the submandibular gland is not a simple part of the facelift operation. There are several maneuvers to perform before considering submandibular gland removal. If you already have no jawline, a proper deep plane facelift with removal of the submental / neck fat will give you a much improved jawline. Submandibular gland removals are associated with increased risks of fluid collections, bleeding, nerve injuries, and increased post-op swelling.

Thank you for your question. While submandibular gland reduction can be performed safely by a very experienced surgeon, most doctors consider this procedure too high risk to recommend it to patients. I can tell you that there are a variety of techniques that can help you achieve an excellent result from a neck and facelift, as long as it is performed by a board-certified facial plastic surgeon with the expertise to tailor your procedure to your precise needs and goals. I recommend finding the best surgeon in your area for the job to ensure an optimal outcome.

Your sub mandibular gland helps keep your mouth moist with saliva. In some people, overtime, the gland gets enlarged and can show up as a bump below the mandibular border and can be more visible after a face and neck lift. Some surgeons remove a portion of the gland in order to better define the jawline. In the proper hands this can be a safe procedure but usually requires drainage tubes be left in for longer periods of time to minimize possible saliva collections in that area. There is also a higher risk of bleeding and possible nerve damage just because of the proximity of these structures to the portion of the gland that is removed. You should have a detailed discussion about this with your plastic surgeon to be sure that this would be a good option for you. Best wishes.

Hello weewers. The majority of patients don't usually need reduction of submandibular glands as part of facelift/necklift, but those that do get nice improvement in their neck/jaw contour. Who will benefit is very difficult to determine based on pictures and really requires examination (and in some cases, imaging) to be certain. Of course, every surgery has risks for complications, and reduction of submandibular glands does carry some additional risks. One of the nerves that move the lower lip travels near the gland (marginal mandibular nerve, a branch of the facial nerve) and can be injured during reduction and/or excision. Also, the glands have very good blood supply, so you may have an increased risk of hematoma. It also carries some risk for sialocele (collection of saliva under the skin) or salivary fistula, and possibly dry mouth. As others have pointed out, visualization is much more difficult trying to approach these glands from the facelift incision, and if they are going to be treated, in my opinion should be approached by an incision under the chin. Hope this is helpful, best regards, Brian

In my practice, I've gone through phases of treating submandibular glands with partial reduction, non excision with direct plastymal plication over the gland, or non treatment. Having direct experience with gland removal through my original training, removal of glands via the facelift incision is compromised by poor visualization and poor exposure. Anytime exposure is compromised, there is always increased risk of lip paralysis, post operative hemorrage with hematoma, or even salivary fistula, in spite of the expertise of the operator. Some surgeons may have good experience with this, but most will not take on additional risk.

Thanks for your question. It is difficult to say from your photos how much these glands contribute to your neck line. They can be removed, but are more commonly reduced in size - but this is not without some considerable risk. There is an artery to your face that runs through the gland, along with a nerve that controls the lower lip and mouth that travels over the top of the gland. These are placed at risk when operating on the gland. For this reason, many surgeons, myself included, try to avoid operating on the glands for aesthetic purposes. There are a multitude of other techniques used to improve your neck and you will only know what is right for you after visiting with a board certified facial plastic surgeon well-versed with facial and neck rejuvenation.