Necks Level
The submandibular gland debate
The conversation around submandibular gland reduction (as part of a deep structural neck lift) has ramped up in recent years, moving from aesthetic-conference stages to social-media soapboxes. While some surgeons say with absolute certainty that, in the majority of patients, they cannot get an optimal neck angle without going under the platysma to trim the salivary glands (as well as adjacent fat pockets and digastric muscles), others insist that the importance of gland reduction has been overstated and that, in many cases, they can achieve crisp contours without shaving the glands.
Truly, there’s no shortage of expert opinions on this topic…
When covering the debate for Allure , I spoke to surgeons, like L. Mike Nayak, MD, T. Gerald O’Daniel, MD, and Dino Elyassnia, MD, who whittle the glands as a matter of course, in almost every first-time face and neck lift. I also interviewed surgeons at the other end of the spectrum, like David Rosenberg, MD, and Amir Karam, MD, who never touch the glands. Somewhere in between are surgeons who perform gland reduction, but more selectively: Gabriele Miotto, MD, in about 70% of cases; Garrett Locketz, MD, in 50%; and Ira Savetsky, MD, in 10%.
The big takeaway: Some of the most esteemed facelift surgeons in the world hold vastly different views on submandibular gland reduction—views shaped by their training, taste, experience, and comfort level. Technique aside, however, everyone agrees that the goal of a modern neck lift should be soft, clean definition—think: '90s-supermodel angles—nothing severe, unnaturally sharp, or overly sculpted.
Beyond exploring surgeons’ reasons for treating or avoiding the glands, the Allure story delves into the controversial history of the procedure—certain giants in the field once claimed cosmetic gland reduction was tantamount to malpractice—while also examining the risks of reduction and warning of a rise in complications.
Dr. O’Daniel fears that submandibular gland surgery could “become the Brazilian butt lift [BBL] of the future, where complications are much more common.” He reminds me that the surgeons who first developed the BBL took a slow-and-steady approach, studying the procedure, practicing it, and performing it with caution. But as the BBL took off, and more surgeons began offering it—often without the necessary training—complications skyrocketed and the BBL earned a lethal reputation. Likewise, he says, the doctors who pioneered gland reduction decades ago were mostly meticulous and unhurried, but with the procedure now exploding, danger looms. “The risk absolutely outweighs the benefit if you’re not prepared,” he says.
If you’re considering a face and neck lift (or an isolated neck lift), you’ll want to read the story in full (pausing to admire the stunning before and afters). As you’ll see, the piece is rather long—but not as long as it could have been, lol. My editor did some careful trimming of her own. (Apparently, the masses don’t want to read 5,000 words on submandibular glands—go figure.) Since I know you all appreciate the finer points of these discussions, I’m sharing here the best of what was cut.
