I am considering a neck lift. Should I remove the large gland in my neck?

Question

I am considering a neck lift. I have a large gland in my neck. The plastic says they do not remove them. I have heard others remove them to create a better profile. Which is correct? Is it possible to “tuck” them back in place?

Lucian Ion, FRCS · Answer

Thank you for your question.

If the submandibular glands are noticeable before surgery, they are likely to become more visible after surgery.

The very reason they have come under scrutiny for cosmetic intervention is because of their tendency to disrupt the landmarks of the neck and jawline.

Suspension of the glands is not usually successful. There have been attempts to reduce them using botulinum toxin treatments but with no established tack record of success.

Lexie Wang, MD · Answer

There are many ways to handle the "large glands" in the neck. Some people remove them/partially remove them, and sometimes you can tuck them up. I would completely rely on what your surgreon says because they are probably guiding you best based on what s/he has seen. However, you could always consider a 2nd opinion with another surgeon.

Jeffrey M. Darrow, MD · Answer

The glands that you are talking about in your neck are your submandibular glands. You’re correct that some doctors do not touch them, other doctors will partially remove them to improve the contour of the neck.  They can be partially improved by the traction placed on the platysma muscle in the neck when the SMAS is tightened, but if they are very large, they may still be visible. If they are to be partially removed, care must be taken to avoid some large blood vessels that run through the gland, as well as some of the nerves supplying the muscles around your mouth.  Additional drains need to be placed in the area of the gland removal to minimize the possibility of a saliva collection and you would need to be on a special diet which minimizes saliva production for several days.  I am not aware of any reliable method which push the glands up,  nor any treatment which effectively shrinks the glands. Speak at length with your plastic surgeon about this. Best wishes.

Jacob Tower, MD · Answer

Hello, hope you are well. Salivary gland reductions (usually partial excisions) have become a more common aspect of deep neck lift surgery, but it remains the minority of patients that require this. Gland excision is perfectly fine in the correct circumstances, but there are some additional inherent risks associated. Whenever possible, they can be "tucked" back into place instead. There is no universally correct answer, and without seeing and feeling your neck I don't think anyone here can give you an informed opinion on whether it's necessary in your case. 
Best,Dr. Tower

Caner Kacmaz, MD · Answer

Hi! This is Arzu from Dr Caner Kacmaz Clinic. 
We need to see your photos to make an evaluation of your case and give you the best solution.
Kind Regards

Thomas Spalla, MD · Answer

Without pictures, it's a little difficult to give specific recommendations. Most commonly, we would be talking about the submandibular glands (SMGs)- located along the mandible. I have to assume you aren't talking about a large thyroid (goiter).

Assuming SMGs:
That region can have fullness from: fat, SMGs that are large or ptotic, and/or prominent anterior digastric muscles. Some, or all, of these may need to be addressed for an optimal profile.
These structures should be able to be determined as a factor in your neck aesthetic concerns.
If they are, then seek a surgeon adept at managing such situations or else I fear you'll be unhappy with the results even if everything else is "perfect."

Michael S. Kluska, DO · Answer

If you have ptotic or saggy submandibular glands , partial removal will aid in giving you a more definitive neck angel. I would recommend that you meet with a surgeon who is familiar with this anatomy so that you can maximize the results of a neck lift.

William Portuese, MD · Answer

Much more information is needed, such as your age and a full set of facial photographs from all angles to make a determination about which procedure is best for you. If you're over age 50 and your skin tone is in elastic in the neck, you're going to need a lower face and neck lift. It is important to understand that there are two compartments of fat in the neck, and they're located both above and below the platysma muscle. Liposuction can only accomplish removal of the fat compartment above the muscle, while a surgical neck lift is required to remove the fat deposits below the muscle, which also includes a platysma plasty to significantly improve the jawline. If you are referring to the submandibular glands, a partial excision can be  performed, when only but only when necessary for contouring.

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