What can be done about bulging submandibular glands? (photos)

Question

I had a facelift 7 months ago, I was aware of my gland problem then but it really does detract from m my result, would I need a GA to remove them? Is it even sensible to remove them? Can they be shaved? When I push them up, my neck moves so much more freely.

Timothy R. Miller, MD · Answer

Prominent or "bulging" submandibular glands can be SAFELY reduced during a face/neck lift procedure.  During your consultation the prominence of the glands should be identified and discussed.  Afterwhich, many of my patients will request for me to reduce them while others are not bothered by the prominence.I do believe the results are often better when they are reduced (by partially shaving them), but excellent results can be achieved without their reduction.  Although possible, a noticeable reduction in saliva is exceedingly, exceedingly rare because only a portion of the gland is removed. Additionally, in my opinion, only experienced, well-trained facial plastic or plastic surgeons should be performing this type of procedure.I hope this helps.

Kenneth Yu, MD · Answer

Hello.  Having a low submandibular gland can sometimes limit the results from a facelift.  If it's noticeably lower, some surgeons will reduce or shave the bulk of the gland at time of facelift.  While this sounds easy, I believe one risks some problems (such as scarring, bleeding, and injury to a facial nerve branch).  Removing the gland is another option.  However, I believe good exposure is key to safe removal.  Important structures (facial nerve branch, lingual and hypoglossal nerves, facial artery and vein) are all in close proximity.  Removing the gland is very simple and safe with good exposure---none of which are present (in my opinion) if one uses just a submental incision or facelift incision.  Ideally, if you already have a skin crease 1-2 cm below your jaw, then I would favor using that incision to remove the gland in a traditional head & neck surgical approach.  The scar will heal very well.  I recommend you discuss this issue with your surgeon; you may even have to talk with several surgeons who feel differently than me and find the one that you feel most comfortable with.  Best wishes.

John J. Martin, Jr., MD · Answer

Unfortunately prominent submandibular glands will usually be more noticeable after a facelift.  There are some surgeons who will remove this gland from a submental incision.  It is not an easy or routine part of a facelift, but if you check around you should be able to find someone who can do this for you.

Lee A. Gibstein, MD · Answer

I agree with my colleague's comment wholeheartedly. Removal of submandibular glands at the time of facelift surgery is not done commonly as part of the procedure and sometimes facelifting can actually unmask glands that may be less visible with skin laxity and submandibular fat.An effective and safe option can be injection with Botox. This will shrink the gland and does not usually cause xerostomia, medical term for dry mouth, which is a real risk with removal of the glands. The Botox injections must be localized and done by a board certified Plastic Surgeon or Dermatologist with significant injection experience since this is an atypical indication.As a reminder, Botox injections are temporary so if happy you would have to repeat in the futureBest of luckDrG

Gustavo A. Diaz, MD · Answer

I have had several of my patients with this problem and also I have had numerous other patients from other physicians coming to my office for second opinion about this problem. These are the recommendations that I give to all patients.1. Glands can be removed partially, but it comes with a risk of fluid collections, hematoma (blood collections) and/or damage to the marginal branch of the facial nerve (problems moving the mouth). I have done several partial resections with success, but I discourage this approach as I consider that the risks are too high for very little to gain.2. Botox injections can be used into the gland. The gland will shrink in size, but it will need serial injections every 6 months in order to maintain the smaller size. You will still be able to see the gland, but the size will be less. How much smaller varies from person to person.3. Do nothing. Accept the gland as what it is. This is the most common recommendation that I give to my patients even before the facelift surgery when I see that they might have this problem at the end. The majority of the patients that I see opt for this alternative. The ones that use Botox are happy with the results that Botox give, but after 1-2 years around 75% of patients stop using Botox and accept the prominent gland.Hope this helps,Dr. Gus Diaz

What can be done about bulging submandibular glands? (photos)

Answers (6)