Creating a much improved neck shape is one of the primary goals of a facelift. (aka lower facelift or necklift) Manipulating the neck tissues of the skin, fat and platysmal muscle are standard therapies and will create very pleasing changes in the vast majority of facial aging patients. The other structure of the neck that can cause some undesireable neck contour changes is that of the submandibular gland. In some patients a low position of the submandibular gland or submandibular gland ptosis can create an unaesthetic bulge on the sides of the neck. As a s result some plastic surgeons advocate submandibular gland removal for an improved neck contouring result.
The submandibular glands are paired structures at the side of the neck that lie above the digastric muscle. They can be felt just below the lower edge of the jaw (mandible) on each side of the neck particulalry if one tilts their head forward. Technically the submandibular glands have two lobes of which the largest is the superficial lobe with the mylohyoid muscle running under it. There is a common duct that drains the gland into the mouth which runs around the back edge of the mylohyoid muscle. While it is one of the major salivary glands it does not produce as much saliva as that of the larger parotid glands.
In the September 2013 issue of the journal Plastic and Reconstructive Surgery an article was published entitled ‘Submandibular Gland Reduction in Aesthetic Surgery of the Neck: Review of 112 Consecutive Cases’. This was a retrospective review of 112 facelift patients in which the submandibular glands were removed over a ten year period. These patients represented around 13% of all primary facelifts done and 25% of secondary facelifts. The vast majority of patients were women. (almost 90%) Major complications averaged 2% which were due to bleeding. (one patients died) More minor complications that eventually resolved on their own were occurred around 11% including salivary gland leak and facial nerve weakness. (marginal mandibular nerve palsy) No patient reported any permanent dry mouth. problems.
While submandibular gland removal can be done during a facelift through the large skin flap raised, complications can occur from bleeding, nerve weakness and a salivary leak. These do add to the list of complications from a facelift and indicate their should be a compelling reason for submandibular gland removal for aesthetic purposes. This study is an impressive number of patients who had this complementary procedure as part of their facelifts and provide evidence that, while not a procedure without risk, those risks are fairly low and manageable.
Dr. Barry Eppley