Partial Submandibular Reduction During Deep Plane Lower Facelift - Is It Common? Risks?

Question

70 year male considering a deep plane lower face lift with partial submandibular reduction. Last discussion on this site in 2020. In 2026 is it more routinely used, assuming skilled provider? Is permanent dry mouth or nerve injury common or rare? Should it be done with intubation or is sedation anesthesia acceptable ?

Mert Demirel, MD · Answer

Partial submandibular gland reduction can be done during a deep plane lower facelift or neck lift, but it is still not a routine step for every patient. It is a selective deep-neck contouring maneuver used when prominent submandibular glands are a major reason for fullness under the jawline.
In 2026, more surgeons are comfortable discussing deep neck work than in the past, but gland reduction remains advanced and anatomy-dependent. It should only be done by a surgeon who regularly performs deep neck contouring and can clearly explain why the glands, rather than fat, platysma, digastric muscle, chin position, or skin laxity, are the limiting factor.
Permanent dry mouth is generally considered uncommon when only part of the gland is reduced and the opposite gland remains intact, but it is not impossible. More common concerns include swelling, bleeding, salivary leak or collection, temporary numbness, contour irregularity, asymmetry, and prolonged firmness.
Nerve injury is also uncommon in experienced hands, but it is one of the key risks. Important nearby nerves include branches that affect lower lip movement, tongue sensation/taste, and tongue movement. Most nerve irritation, if it occurs, is temporary, but permanent injury is a serious possible complication that should be discussed directly.
Regarding anesthesia, this is usually surgeon- and patient-dependent. Because gland reduction is deeper neck work with bleeding and airway considerations, many surgeons prefer general anesthesia with a secured airway, especially in a 70-year-old patient or when combined with a longer facelift. Some may perform selected cases under deep sedation, but safety, airway control, and blood pressure management are critical.
My advice would be to ask your surgeon how often they perform partial submandibular reduction, what complication rates they personally see, whether they use drains, how they manage salivary leaks or bleeding, and why they think your glands need treatment. If the gland is truly the limiting structure, it can improve neck contour, but it should be approached as an advanced selective procedure, not a standard facelift add-on.

Gerald Minniti, MD, FACS · Answer

You are correct, it is much more common now than ever before. It is also much safer than before with proven techniques of reduction as well as a device called the Ligature. Deep plane neck work can result in temporary nerve injuries infrequently. The affected nerve is the marginal mandibular nerve, which leads to weakness in the lower lip depressor muscles. This weakness usually resolves in one to two months and is typically not noticeable. Dry mouth does not occur.

William Portuese, MD · Answer

In our practice, we only a partial component of the submandibular gland when necessary and when it is extremely large, causing a significant bulge in the neck. A Partial submandibular gland reduction does not give a dry mouth. A deep neck lift is performed under general anesthesia with a breathing tube in place. Never under IV sedation. On occasion, it can cause a stretch of the marginal mandibular nerve which controls the lower lip that usually takes 6 to 8 weeks to go away and it's only temporary in our experience. The deep plain neck lift is a. complicated procedure, so choose your surgeon wisely based on extensive experience. Study your prospective surgeon's before and after facelift photo gallery and study the results of their work.

Ronald J. Edelson, MD · Answer

Reduction of submandibular glands is one of those subjects that you might hear about more and more these days with social media., however I think surgeons who actually do this during facelift are in the vast minority, it’s just not worth the risks, mainly nerve injury. I think some surgeons use it as a selling point

Dallas Buchanan, MD · Answer

Thank you for this important question. Lots of great things to discuss here. First, is partial SMG resection common in deep plane neck lifting? I would say, no, it is not common. Mostly because there are significant risks to the procedure and it can be technically difficult, so many surgeons choose not to pursue it. However, I routinely perform this procedure in my practice because I think it makes the contours of the neck better and leads to overall better cosmetic results in some patients. In qualified and experienced providers, dry mouth issues and permanent nerve injury are going to be very rare. But it becomes even more important to choose a provider with experience and expertise in the procedure. As for the anesthesia, we perform all of our head and neck procedures using TIVA (total intravenous anesthesia). While this technically is "general anesthesia" meaning that your brain is knocked out and you are asleep, it is very typical for our patients to be breathing on their own and need nothing other than a nasal cannula during the procedure for airway support. No intubation (unless necessary) and no inhaled anesthetic agents. I would not perform SMG surgery under sedation. Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Julian De Silva, MD · Answer

Hi Travel365, this is a well-informed question and it deserves a careful answer.

Partial submandibular gland reduction remains a selective step rather than a routine part of a deep plane lower facelift. It is considered when the gland genuinely sits below the jawline and is still visible after the deep layer has been repositioned and the platysma addressed. In a good number of necks it turns out not to be needed, because what looks like a gland is subplatysmal fat or a lax muscle edge instead. Telling those apart is an examination, not a photograph.

On risk, the marginal mandibular nerve and nearby vessels run close to that field, and bleeding in this area matters more than elsewhere. Permanent dry mouth would not be expected from a partial reduction of one pair of glands, since the other salivary glands continue to function, although temporary change can occur. Reported rates vary widely with how selectively and how frequently an individual surgeon performs the step, so asking your surgeon that directly is entirely reasonable.

On anaesthetic, deep plane surgery can be carried out under sedation with local anaesthesia, and I do this routinely in my own practice. Adding gland work does place more demand on the anaesthetic and airway plan, so that decision belongs to you, your surgeon and your anaesthetist together, informed by an in-person assessment of your general health at 70.

Two questions worth asking any surgeon: how often do you perform this specific step, and what do you do when the gland turns out not to be the cause.

Partial Submandibular Reduction During Deep Plane Lower Facelift - Is It Common? Risks?

Answers (6)

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