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When patients think about a neck lifts, they usually think about removing fat and tightening loose skin. Although skin and fat are important factors to address in a neck lift, sculpting the deeper structures—particularly the submandibular glands—can often have a more powerful, lasting impact on a neck lift outcome.
The submandibular glands are salivary glands located underneath the jaw, one on each side. Everyone has them, but they vary considerably in size and position. In some people, they are relatively small and sit high enough under the jawbone that they have little effect on the appearance of the neck. In others, they are larger or sit lower and can create significant fullness directly beneath the jaw. This is an important consideration when performing a neck lift because the gland itself does not simply disappear when the surrounding tissues are tightened.
Why the Submandibular Gland Matters
One of the most common reasons patients seek a neck lift is to create a sharper transition between the jawline and the neck. For many patients, the submandibular glands are an important obstacle to achieving that goal. As we remove or reposition the tissues around the neck, the underlying anatomy becomes more apparent. A submandibular gland that was not particularly noticeable before surgery can become much more obvious once the surrounding fat has been reduced and the tissues have been tightened.
This does not mean that the gland has suddenly become larger. It means that the gland was always there, and the surrounding tissues were previously masking some of its prominence. A technically excellent neck lift will leave fullness beneath the jaw if a prominent submandibular gland is not addressed.
Why I Frequently Reduce the Submandibular Glands
I evaluate the submandibular glands in every patient undergoing a neck lift, and I perform some degree of gland reduction in the vast majority of my neck lift cases. My reasoning is that I do not believe tightening the platysma alone can reliably hold a prominent submandibular gland in a high enough position to produce the best possible long-term contour.
The platysma is an important part of a neck lift, but it is a very thin muscle sitting over the gland. If the gland itself is large or positioned low, tightening the platysma over it does not make the gland smaller. In my experience, it also does not reliably keep a prominent gland elevated over time. If the gland is contributing significantly to the contour, I address the gland itself.
I Don't Simply Remove More Fat
Unlike most plastic surgeons, I rarely remove any subcutaneous fat during a neck lift. It may seem intuitive that removing more fat would produce a more defined neck, but excessive removal of subcutaneous fat can create a hollow or prematurely aged appearance, particularly as the face and neck naturally lose volume with age. Instead, I preserve the superficial fat and focus on the deeper structures that are actually responsible for the fullness.
The submandibular glands are one of those structures. The digastric muscles can also contribute in certain patients, and I will reduce them when appropriate. Extra skin is surprisingly rarely the primary problem in my neck lift patients. The point is not to remove everything that contributes to volume. It is to identify which structures are creating an unfavorable contour and selectively address them.
What Does Submandibular Gland Reduction Involve?
Submandibular gland reduction involves carefully exposing the gland and reducing the portion that contributes to the contour of the neck. I perform a partial reduction, reducing its bulk while preserving its function. This is a technically demanding procedure because the gland is located near important nerves and blood vessels. Submandibular gland reduction is a technique that should only be performed by surgeons with extensive experience in deep neck surgery. It requires mastery of the anatomy and experience working in this area.
What Are the Risks?
The most important risks of submandibular gland reduction include postoperative bleeding and injury to nearby nerves including the marginal mandibular, which can result in temporary weakness or asymmetry of the lower lip. In very rare cases these deficits can be permanent. Other potential complications include changes in salivary function and wound-healing problems.
These risks are real and need to be weighed against the potential benefit for each patient. I do not believe that every patient needs aggressive gland reduction. The degree of reduction should be based on the size and position of the gland and how much it is contributing to the patient's neck contour.
Specialized Equipment for Deep Neck Surgery
Because submandibular gland reduction requires working deep in the neck around important nerves and blood vessels, I use specialized, single-use instruments designed specifically for deep neck surgery. These instruments are expensive, but I believe they provide better precision and control when working around these delicate structures. My goal with this equipment is not simply to make the operation more sophisticated. It is to make a technically demanding procedure as controlled and precise as possible and to reduce the risk of complications.
Who Is a Candidate?
Not everyone needs submandibular gland reduction. Some patients have relatively small, high-positioned glands that contribute very little to their neck contour. In those patients, there may be little reason to manipulate them. Other patients have larger or lower-positioned glands that are clearly contributing to fullness underneath the jaw. These are the patients in whom I believe gland reduction can make a meaningful difference. The only way to determine this is through a careful examination of the neck.
One of the questions I frequently discuss with patients is not simply how much fullness they have, but what is causing that fullness. Is it fat? Is it the platysma? Is it the submandibular gland? Are the digastric muscles contributing? Is there actually excess skin? Those questions are important because each requires a different solution.
The Goal of a Deep Neck Lift
My approach to neck rejuvenation is not to remove as much tissue as possible. In fact, removal of superficial fat can often make the neck look older rather than younger. Instead, I try to preserve youthful superficial volume while selectively addressing the deeper structures responsible for fullness. For many of my patients, that means reducing the submandibular glands as part of the neck lift. The goal is a sharper jawline and a cleaner neck contour without creating a hollow or overly operated appearance.
Frequently Asked Questions
Does everyone need submandibular gland reduction during a neck lift?
No. The size and position of the glands vary from patient to patient. Some patients have very little gland prominence, while in others the glands are a significant contributor to fullness beneath the jaw. I evaluate the glands in every neck lift patient and determine whether reduction is appropriate based on their anatomy.
Why doesn't tightening the platysma fix the problem?
Tightening the platysma can improve the neck significantly, but it does not make a large submandibular gland smaller. I also do not believe that platysma tightening alone can reliably hold a prominent gland in a suspended position for more than a few months.
Why don't you remove more fat from the neck?
I preserve subcutaneous fat because removing too much can create a hollow or prematurely aged appearance. When there is significant fullness beneath the jaw, I often focus instead on deeper structures such as the submandibular glands, digastric muscles, and deep (visceral) fat.
Can the digastric muscles also contribute to neck fullness?
Yes. In some patients, bulky digastric muscles contribute to fullness beneath the chin and jaw. When they are a meaningful part of the problem, I reduce them at the time of the deep neck lift.
Is submandibular gland reduction safe?
It can be performed safely by surgeons with specialized training, but it is not without risk. Experience and specialized instrumentation are particularly important when performing deep neck surgery.
What makes your approach different from a traditional neck lift?
Rather than focusing on removing superficial fat and tightening the skin and platysma, I place considerable emphasis on the deeper anatomy of the neck. When the submandibular glands are contributing to fullness, I prefer to address them directly rather than relying on platysma tightening alone. The goal is not simply a tighter neck. It is a neck with a cleaner, more defined jawline while maintaining a natural and youthful appearance.