Why do some facelifts appear "Joker-like" and show large salivary glands sticking out on the side of the neck?
Doctor Answers 8
Some face lift techniques are more prone to these and some patients faces are more prone to this. Good luck.
Over pulled lift
The short answer is that it is likely a combination of the surgeon's aesthetic and the patient's demand. While most surgeons will pride themselves on achieving a natural looking result and most patients request this there is most definitely a group of patients who demand "super tightness" and want people to notice their lift. They will find surgeons who offer this type of result.
If wide subcutaneous undermining and heavy pull is performed the joker look is obtained. Most surgeons now do less undermining and more deeper SMAS modification to retain a natural look. I hope this helps. Good Luck!
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Hello and thank you for your question. The simple answer to your question to carefully evaluate before and after pictures of the surgeon you are choosing and make sure you like what you see. If good technique is used,
a facelift can be done with minimal scarring and can result in a natural look, not
over-done look, with rejuvenation of your face. The most important aspect
is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
There might be many reasons for the overpulled look. These patient might be repetitively unhappy, and end up seeking multiple procedures and multiple revisions to their faces, or their doctors are doing a very tight skin closure or are doing more horizontal instead of vertical pull. You can't really comment on pain based on the look of tightness and it may not be painful. Lifts are marked pre op to determine proper pulls to deal with problem areas. True salivary submandibular glands can become more evident in thin liposuctioned necks but I'm not sure that's what you're looking at.
Facelift techniques that produce pulling of tissue more back than up can create this look. The most natural facelift creates mosly upward lift, which also creates natural neck improvement at the same time. I prefer the deep plane technique to achieve this.
Over pulled look
Thanks for sharing your question. I can appreciate your concern.
The redundant salivary glands are secondary to the plication technique on patients that have excess tissue. In those patients excision is better for the final outcome.
Personally I do not think that over pull is a good technique because it is difficult to predict when to much is too much. Adequate pull or minimmaly overcorrected should be a better approach. At the end the bottom line is do you like the outcomes your plastic surgeon is giving you on patients followed for a year. If that is the answer then pick that surgeon.
Finally, make sure that you have a consultation with a board certified plastic surgeon.
Wishing you the best in your journey
Facelifts and Salivary Glands
The short answer is that thinner necks or those patients with large submandibular glands will be more likely to have glands that show after a lift. The tighter skin appearance is another matter. The lift should contour the neck, lift the face and improve or eliminate the jowels in a manner that does not make the patient look pulled. Some patients are not happy unless they look overdone and other times it is seen when a surgeon uses a skin only approach.
Talk to your docter, review photos and ask to speak to previous patients.
Best of Luck
A. Dean Jabs M.D. Ph.D. FACS
Board Certified Plastic Surgeon
6430 Rockledge Drive
Bethesda MD 20817
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.