Is resecting the submandibular glands appropriate for my face/neck lift? (photos)

Question

In addition to lots of defatting and tightening of my neck, the BCPS plans to remove or thin or something to these glands. This sounds pretty scary, and I was told there might be less saliva. So many questions. Attaching lots of pics, not sure if it's enough for an opinion, but I would appreciate whatever advice you have. Thank you so much for all of your help!

P. Daniel Ward, MD · Answer

The submandibular glands can increase fullness under the jaw, but removal of the glands is only rarely needed to obtain a great result.  I suspect that you would get a great result without removal of the glands and would advise you to discuss this with your surgeon in detail.  Removal of these glands does not typically lead to dry mouth or anything like that, but it can lead to weakness in one of the branches of the facial nerve (the nerve that moves the corner of your mouth downward) and can potentially lead to tongue numbness or paralysis.  Good luck!

Kevin Sadati, DO · Answer

Large submandibular glands poses a
challenge post face and neck lift. It can protrude and cause irregular shape
under the jawlines. In the past surgeons removed part of this gland to reduce
the size of it. Injection of Botox can reduce the size of these glands after
facelift surgery.

I concur
with my colleagues; I do not recommend submandibular resection since dry mouths a bad problem to have.

Justin Yovino, MD, FACS · Answer

Downsizing the submandibular glad is an option but it's not commonly performed. It does add risks to the procedure as previously mentioned. You'll have a nice result without thinning the gland.

Parker A. Velargo, MD, FACS · Answer

While you do have some minimal submandibular gland show in your photographs, correction of the jowls, jawline, and neck with a routine type facelift should offer great results.  The key to happiness following facelift alone in your case; however, lies in your realistic expectations.  Because the glands are somewhat low lying, you may always see a slight bulge following facelift.  If you are okay with that, then the risk of removing/ reducing the submandibular glands is not worth taking in my opinion.  I am not a proponent of resecting submandibular glands as part of a facelift because I do not typically find that the benefits outweigh the risks (e.g. facial nerve damage, dry mouth).  Even in patients who have more submandibular gland show than you, some doctors prefer to try and shrink the glands with Botox injections rather than remove them.  Of course, cost and the need for repeated injections must be weighed with this option as well.  Address your concerns with your surgeon, and find out his experience and results with submandibular gland excision.  It may be a great option in his hands.  Regardless, you are a great face and neck lift candidate, and I wish you the best in whichever route you take.

David C. Yao, MD, FACS · Answer

Thank you for sharing. Occasionally the submandibular gland is removed or reduced based on physical examination. As with any specific decision there are specific pros and cons. Consider what is important to you and discuss fully with your PS. If it doesn't seem or feel right, this doesn't need to necessarily be a part of your procedure. A good facelift doesn't necessarily require a gland resection. Hope this helps.

Michael I. Echavez, MD · Answer

Personally, I am not a big fan of resecting the submandibular glands.  There are other salivary glands, so resecting them should not necessarily make a difference in saliva production but the procedure is not without risk.  I think that you could get a decent result from surgery without resecting the glands, but that is just my opinion.

Laxmeesh Mike Nayak, MD · Answer

The submandibular salivary glands commonly enlarge and descend with age. When the more-noticeable aging changes of loose/excess fat, muscle, and skin are addressed in a neck lift, these glands are sometimes unmasked. Critical nerves exist immediately "over" and "under" these glands, so they are often not addressed with face/neck lifting surgery.A few expert neck lift surgeons are comfortable safely treating these glands. Seek one out.In my experience, the high/lateral jawline and neckline can *only* be optimized if these glands are treated. Dry mouth has not been a long-term concern.

Robert Kotler, MD, FACS · Answer

Dear Tucson Friend;It seems that the submandibular
salivary glands are probably located a little lower in your neck. Ideally, if they are just under the edge of
the mandible, they are not visible. When
you have a face and necklift -- and it looks like you’re certainly a good
candidate because your skin looks good and elastic -- there will be a lot
of fat removed and most likely some tightening of the platysma
muscle. It may be that the submandibular salivary glands may be
more visible. Right now, they are
somewhat hidden by layers of fat under the skin.The surgeon’s examination can give a good
clue if that is likely. And it sounds like that may have been the
case at your consultation.Frankly, I have never been keen on
doing that because it adds a lot of complexity to the operation.  The best
procedures are those that have the least complexity. I cannot make a definite recommendation
without seeing you, but I would say my experience over the  years has been -- having operated on
many patients with what appears to be a similar anatomical unacceptability of
the neck-- that yes, sometimes the salivary glands are
a little visible, but the overall improvement is so great that after a while
that imperfection is overlooked.You have to look at cosmetic surgery as
an attempt to improve, but not necessarily create perfection. If the anatomy is very complicated and
unusual, it is not likely one can get a “perfect” result, but you are looking
for substantial improvement. Also,you want a
natural look, not a pulled and overtightened look. Frankly,
removal of the submandibular salivary glands could possibly leave you with a
slight depression. If I were you, I’d have some
more consultations. I think you need to
hear from other surgeons. The question to ask: Is it possible
to have a reasonable result without removing the submandibular salivary glands?
It’s time to do some good
homework, too. Look online at some photos on other
websites, read good books, and have consultations with those surgeons who focus
on the operation you need. I need
not tell you that today the key to success in cosmetic surgery, as well as so
many things in the world, is a high degree of specialization with a long track
of experience. That's what most people
want today .The internet allows
people to search out and find those surgeons who are at the top of the totem
pole in terms of their narrow focus on just a few procedures. You’re always best served by that. Best wishes and good luck. Robert Kotler, MD, FACS

Todd C. Miller, MD · Answer

This is a controversial topic and I don't think that most facial plastic surgeons would advocate for removal of the glands. While removal of the glands is technically a straight forward procedure, there are many risks, and I'm not convinced that the cosmetic outcome justifies the risks. In other words, I think that you would have a very nice result without removing the glands, and removal of the glands would not provide that much more of an improvement to justify the risks.

Shaun Parson, MD · Answer

Thanks so much for your question.  You can have something like that done but you have to be very careful when deciding to remove a salivary gland.  Some facial surgeons do it fairly routinely but it will raise your potential for complications and often time it frankly is not necessary to do it.  You will still have a very nice result if the glands are left in place, in my opinion, with less potentials for adverse effects.  Have a frank conversation with your surgeon and go over the risks at length again.  Hope this helps.

Is resecting the submandibular glands appropriate for my face/neck lift? (photos)

Answers (16)

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