Overview
A prominent submandibular gland can spoil neck contour, especially in East Asian patients with less bony support and less soft tissue to hide it. Fear of deep neck bleeding with breathing problems, nerve injury, sialocele and dry mouth has limited gland reduction. The authors reviewed 240 patients treated from August 2024 to July 2025, with a face lift or neck lift added when needed for loose skin or advanced aging.
Findings
- 240 East Asian patients; partial gland resection during deep neck contouring.
- Method: entry through the inner gland capsule, lobule-by-lobule bipolar dissection, and targeted cautery of vessels inside the gland.
- Thin-film fibrin sealant and low-dose botulinum toxin A were applied to the remaining gland to control dead space and saliva.
- Hematoma: 3 patients (1.3%); 1 needed reoperation.
- Seroma: 3 (1.3%).
- Infection: 2 (0.8%).
- Sialocele: 1 (0.4%), resolved with aspiration and botulinum toxin injection.
- Temporary lower-lip depressor weakness: 4 (1.7%).
- No permanent nerve injury or clinically evident salivary problems during follow-up.
- Standardized photographs showed consistent improvement in jawline contour.
What it means for a patient
- Partial removal of a bulging submandibular gland can be added to deep neck lift surgery to sharpen the jawline.
- In this series, 3 of 240 patients had a hematoma and 4 of 240 had temporary weakness of the lower lip.
- No patient had lasting nerve injury or dry mouth that could be detected clinically.
- Limits: retrospective, one year of enrollment, follow-up length not stated, East Asian patients only, contour scored by surgeons, level IV evidence.
Why this paper matters
It reports low observed complication rates for lobule-based partial gland reduction in 240 patients. The authors suggest selective gland reduction as one part of deep neck contouring in selected patients.
Terms
- Submandibular gland: a saliva gland under the jaw on each side of the neck.
- Sialocele: a collection of saliva under the skin after gland surgery.
- Seroma: a pocket of clear fluid under the skin.
- Fibrin sealant: a surgical glue made from blood clotting proteins.
- Bipolar dissection: cutting and sealing tissue with an electric instrument whose current passes between two tips.
- Lower-lip depressor: the muscle that pulls the lower lip down.
- Deep neck contouring: neck surgery beneath the platysma muscle to reshape the neck.