Submandibular Gland Reduction in Aesthetic Surgery of the Neck: Review of 112 Consecutive Cases

Abstract

Background: The indications for reduction of excessive submandibular gland volume in aesthetic rejuvenation of the neck have been well described, as has the surgical anatomy and the surgical technique. Despite this, submandibular gland reduction does not appear to be widely adopted, nor have significant case series been reported in the literature. This review of a consecutive series of aesthetic submandibular gland reductions was undertaken to provide a perspective about its place in neck contouring.

Methods: A retrospective chart review was conducted of all patients on whom the senior author (B.C.M.) had performed submandibular gland reduction for aesthetic reasons. Complications and reoperations were specifically analyzed.

Results: Submandibular gland reduction was performed in 112 of 736 consecutive face lifts between 2002 and 2013, an incidence of 13 percent in primary face lifts and 25 percent in secondary face lifts. The median patient age was 57 years, and 87 percent were women. Major complications were those requiring early reoperation (1.8 percent) to manage significant hematomas; one was potentially fatal. Minor complications (10.8 percent) were managed nonoperatively. Submandibular sialocele (4.5 percent) and marginal mandibular branch neurapraxia (4.5 percent) were the most frequent, and all resolved fully by 3 months. Significantly, no patient reported a permanent dry mouth.

Conclusions: The complication rate with submandibular gland reduction is comparable to that of a neck lift with platysma plication alone, with some additional specific risks: (1) catastrophic airway compression from bleeding deep in the neck, (2) significant increase of neurapraxias in secondary neck lifts, and (3) a moderate incidence of benign submandibular sialocele.

Clinical question/level of evidence: Therapeutic, IV.

Fig. 1.

(Left) Frontal and lateral views of a 63-year-old woman shown preoperatively. (Right) One year postoperatively, after face lift with small reduction of subplatysmal fat and major reduction of submandibular glands. In addition, the patient underwent prejowl sulcus augmentation (1.0 cc of hydroxyapatite granules subperiosteally) and lower lid blepharoplasty with hydroxyapatite augmentation of the inferior orbital rim and maxilla, and small-volume lipofilling of the upper lids and lips.

Fig. 2.

Patient series showing the results of three procedures over 13 years. These show the difference between neck fullness attributable to fat excess and submandibular gland prominence. (Left) A 39-year-old female patient shown preoperatively. (Right) At age 45, 6 years after primary face lift, with midline platysmaplasty, and no defatting submental or subplatysmal and no submandibular gland surgery. Also, placement of prejowl silicone jawline implant (medium size), coronal brow lift, upper and lower blepharoplasties were performed.

Fig. 3.

Patient series showing the results of three procedures over 13 years, continued. (Left) At age 50, 5 years after a secondary face lift that included submental liposuction and subplatysmal fat reduction with secondary midline platysmaplasty, but not submandibular gland reduction. (Right) At age 52, 15 months postoperatively after tertiary face lift with major submandibular gland reduction. Also, the prejowl silicone implant was replaced with hydroxyapatite subperiosteal augmentation (1.2 ml) and upper lid adjustments.

Fig. 4.

(Left) Preoperative appearance of a 64-year-old woman. (Right) Two years postoperatively after face lift with major submandibular gland reduction and moderate subplatysmal fat reduction. Also, skeletal augmentation of the zygoma and lower maxilla (subperiosteal hydroxyapatite granules), coronal brow lift, upper and lower lid blepharoplasties, and small-volume lipofilling of the upper lids and lips were performed.