Neck irregularity after deep plane facelift & neck lift, thoughts or suggestions please? (Photos)

Question

Results after deep plane facelift and deep neck lift.... i was told i had a (L) submandibular gland and that results would look good with or without removing gland. Btw i had no protrusion of a gland while lying flat on my back prior. I'm having a hard time believing that this is all submandibular gland related... any thought or suggestions please!? Thank you!!

Lucian Ion, FRCS · Answer

Thank you for your inquiry and sharing your photographs. As far as I can tell, there is the possibility of left submandibular gland fullness. However, there is also some contracture band under the skin, which seems to affect the platysma muscle on the left side. This could be improved with steroid injections, but it is likely that the volume of the submandibular gland will still represent a problem.

It is indeed possible that prior to surgery, you had more symmetry, which camouflaged the appearance of the submandibular gland on the left side, and following the surgery, there was more reduction on the right than on the left. If you would like to be sure about the current situation, my suggestion is to have an ultrasound for the soft tissues under the chin. This will reveal the tissue characteristics, and you will know for sure rather than guess.

An MRI scan, in particular a sitting MRI scan, can also demonstrate these features, but is inevitably more expensive.

Erman Ak, MD · Answer

You would benefit from submandibular gland removal to address any gland-related fullness and platysmal correction (e.g., platysmaplasty) to refine the neck contour. These adjustments can significantly improve the overall neck and jawline appearance by addressing both structural and muscular contributions to the fullness. It’s essential to consult with your surgeon to confirm these recommendations and discuss the risks and benefits of revision surgery.
MD Erman Ak

James M. Economides, MD, FACS · Answer

It's understandable to feel uncertain about the relationship between your surgical results and the submandibular gland. In a deep plane facelift and neck lift, the surgeon often considers various anatomical structures, including glands, to achieve the best aesthetic outcome. If there was a suggestion that removing the gland could enhance results, it might have been based on your surgeon's assessment of how it could impact your neck contour.

However, if you had no visible protrusion of the gland while lying flat and were told that your results would be good regardless of whether the gland was removed, it’s natural to question the role it might play in your current results.

Here are a few suggestions:

Follow-Up Consultation: Consider discussing your concerns directly with your surgeon. Ask for clarification on how the gland might be affecting your results and whether its removal could have made a significant difference.

Second Opinion: If you're feeling uneasy, seeking a second opinion from another qualified surgeon could provide more insight into your situation.

Understanding Recovery: Sometimes, the early results can be influenced by swelling, tissue healing, and the overall dynamics of the area, which can take time to settle.

Patient Support: Connecting with other patients who have undergone similar procedures might provide additional perspectives and reassurance.

Ultimately, it's important to feel confident and comfortable with your treatment and its outcomes, so don’t hesitate to advocate for your concerns.

Gianfranco Frojo, MD · Answer

This is a cobra neck deformity. The fat in between the platysmal muscle bands was over resected. The platysmal bands were not adequately treated. The neck skin was not properly re-draped over the area. The fat was not properly contoured in the lateral aspect of the neck. There does also appear to be a slightly bulging submandibular gland as well. This is a common undesired outcome after poor necklift surgery work. I would recommend seeing a board-certified plastic surgeon (American Board of Plastic Surgery) to address your issues.

Carey Nease, MD · Answer

This does not look like it's related to the gland as you mentioned. There is excess skin under your chin on the left more that the right along with persistent bands from the inner border of your platysma muscles. You likely need steroid injections and massage and if it's not better in a few months then you may need a revision to that area. Good luck!

Arthur Dean Jabs, MD, PhD, FACS · Answer

It appears to be related to a deep structure irregularity or scarring from fat removal close to the skin. Have you had steroid treatments in the area? Since the gland was not removed I doubt it is related to a glandular issue.
I would advise speaking to your surgeon and working on a plan together.

All the Best,

Dr. J

Manish H. Shah, MD, FACS · Answer

Hello,
Thanks for your question. I can't see a scar under your chin so my guess is that you did not have central submental neck surgery to manage the platysmal bands (and you stated your surgeon did not operated on the submandibular glands.)
If you've only had an isolated deep plane facelift, the SMAS tightening tends to flatten the area of the neck behind the gland and can make it pop forward. The gland is always easier to see in the upright position and can hide when lying down. Central neck surgery for platysmaplasty and possible left submandibular gland reduction surgery is probably necessary to improve what you see in your pics.
I hope this helps.
Dr. Shah

Jacob Tower, MD · Answer

Hello, hope you are well. This does not appear to be ptotic submandibular gland(s). It appears more like a cobra neck deformity which usually happens from excessive reduction of the central neck contents. The visible protrusions are muscular in nature. This can be revised, but a good initial step would be applying botox to the muscles under the skin to see if that can correct the problem.

Best,
Dr. Tower

Best,
Dr. Tower

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