Salivary glands and facelift?

Question

I am considering a facelift but my concern is the salivary glands and how they will be addressed in this procedure. I am slim and I can see and feel the submandibular salivary glands so it concerns me that with a tighter jaw/neck line they will be much more apparent. What is done during surgery to avoid this problem? I know I am not Robinson Crusoe here.

Howard Webster, MBBS (Hons), FRACS · Answer

Hi there, I've enjoyed reading this thread and your question because of the variety of opinions I knew it would bring.My comments are a little different.I completely agree with you. The submandibular glands, if visible preoperatively, as an issue.  They're always visible post op if visible preop and sometimes they are even more visible. In this event they detract from the neck result.I don't believe the suspension techniques work well. The best way by far to eliminate the gland visibility is a subtotal resection which works well and looks good. It doesn't seem to cause a dry mouth, there are other salivary glands, although medically you should have no history of connective tissue disease if considering this.Why don't plastic surgeons take the gland out or operate on it very much?  Because it's hard and a little scary, that's why, and many surgeons are frightened of it.  Access can be difficult - the approach is a small incision under your chin. It can bleed - the large facial artery runs over it, and the facial vein under it- and there are relevant nerves in the area.  So the truth is that many plastic surgeons if not most, will just not ever operate to take out the gland - and they'll have various reasons they'll tell you for choosing not to do this.I don't much like taking the glands out. I've learnt that when I need to, to allow adequate operative time for it.  I allow an extra hour - and when planning it, to see it as the most important part of the procedure, not as a little adjunct to the necklift component. I do resect the gland from time to time, and if done with time and care, it's not too bad. But I don't do it all that often.In Melbourne, the surgeon with the most experience in gland resection by far is Bryan Mendelson.I hope this helps,All the bestHoward WebsterPlastic Surgeon.

Mark Karolak, DO, FAOCO · Answer

Enlarged submandibular glands can cause fullness in the neck. This fullness is present before surgery, but it may be a concern for patients afterwards because everything else looks so good. I have found that when patients are made aware of it before surgery as well as risks associated with removing them, it tends to be a non issue afterwards. These can be removed during the surgery, but would add significant risk to the nerve that controls movement of the lips as well as increase the risk of significant bleeding during surgery. Other types of treatments like suspension procedures may be helpful.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi.Excellent question and there are 2 camps of plastic surgeons on this topic.  The first believe that by tightening the platysma it will help suspend the glands and make them slightly less prominent.  The second take a more aggressive approach and remove either part or all of the gland in order to sharpen and improve the jawline profile.  This approach has a higer complication rate including nerve damage and bleeding.  In short you need an opinion from an Australian qualified plastic surgeon who can determine how much of a problem it is and counsel you appropriately.RegardsDamien

Fernando Colon, MD · Answer

This is a good question. Many patients may havenoticeable submandibular glands preoperatively.It is important for the plastic surgeon and patientto discuss it and consider the approach. In generalgood preoperative planing and avoidance of makingthe neck soft tissues to thin works for most patients.Operations directed twards the glands themselvesare rarely required.Best wishes

Vincent N. Zubowicz, MD · Answer

Palpable submandibular glands seldom create contour problem of the neck after facelift provided the platysma muscle is properly dealt with. Rarely a pathologically large submandibular gland might require removal for the best result in the neck.

Keith Denkler, MD · Answer

The submandibular glands can sometimes be a problem after a facelift.Botox can shrink them for  awhile.Or they can be removed, but removal can be risky due to bleeding.

Brooke R. Seckel, MD, FACS (retired) · Answer

You are correct and very thin people with visible submaxillary glands preop, the Glanzer often visible postop and disturb the nice line of a good neck lift result.  Personally I do not resect the glands but use a suspension techniqueswhich in my hands has been adequate.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts over the past 30 years.  Unless your submandibular glands (SMD) are very large or low in position, they should not be made more prominent by a minimally invasive type facelift which is described below.  More invasive type facelifts pull, stretch and therefore thin the Platysma muscle in the neck which can make the SMD appear more prominent.  This is far more common in women than men.  This can be avoided with careful planning in my opinion.  Non smiling photos of your face from the front and side would help in the evaluation.  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.  My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:very small incisionsminimal tissue dissection = less bruising and swelling = rapid recoverycan be performed in 90 minutes or less, with or without general anesthesiano incisions within the hair = no hair lossexcess fat can be removedexcess skin removedcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-op  I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.Hope this helps.

Salivary glands and facelift?

Answers (8)

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