Submandibular Gland Management in Deep Plane Neck Lift: What an 83-Patient Series Adds

A neck can be beautifully defatted, the digastric addressed and the platysma carefully adapted, and still show a soft bulge under the mandibular border. Very often that residual fullness belongs to the submandibular gland. Removing the deep fat that once surrounded it can make a large or ptotic gland more visible, not less.

That is why the gland belongs in the analysis of every neck that is being considered for deep contouring. The question is never simply "remove it or leave it". It is whether the gland contributes to the problem, and if it does, which of several strategies is proportionate for this patient.

Why the gland matters for the neck contour

The 2025 series puts it plainly: in performing a neck lift, the size and location of the submandibular gland must be evaluated to achieve the ideal neck contour. In practice, three things are assessed together:

• Visibility. Is there a discrete bulge in the submandibular triangle, below and parallel to the mandibular border, at rest and with the head in neutral position?
• Behaviour. Does the fullness persist when the platysma contracts? Superficial fat tends to move with the skin; a gland bulge sits deeper and does not pinch.
• Context. How much deep fat will be removed, and how will the platysma be adapted? A gland that is invisible before surgery can become the dominant contour once the overlying volume is gone.

The structured way of reaching that decision is the subject of Reading the neck: fat, muscle, gland or bone?

Why many surgeons avoid gland excision

The same paper notes that many surgeons avoid submandibular gland excision because of its technical difficulty and the risks of hematoma and nerve damage. Those concerns are well founded. The gland is vascular, it is approached through limited access, and it sits in a region where several structures matter:

• the marginal mandibular branch of the facial nerve, superficial to the gland capsule near the mandibular border;
• the facial artery and vein, closely related to the gland;
• the submandibular duct and lingual nerve, on the deep aspect of the gland.

These relationships, and how they look in a real dissection rather than a diagram, are covered in Surgical anatomy of the deep neck: layers, landmarks and danger zones.

Three strategies: preserve, support or reduce

On Day 01 of All About The Neck, the gland lecture is framed around exactly these options:

• Preserve when the gland is not responsible for the contour problem. Many necks do not need gland surgery at all.
• Support a ptotic gland with suture-based techniques when position, rather than volume, is the issue.
• Reduce conservatively when a prominent superficial portion remains visible after deep contouring. The aim is a partial reduction of what protrudes, not removal of the whole gland.

Whichever route is chosen, vascular control and the management of salivary complications have to be part of the plan from the start.

The 2025 series: what was done

Op. Dr. Mehmet Cömert, co-host of All About The Neck, and Dr. Karaca Basaran reported 83 patients who underwent submandibular gland excision during deep plane neck lift between 2018 and 2022. In every patient the gland was partially excised using LigaSure (Valleylab, Boulder, Colorado), a bipolar energy-based instrument that permanently seals vessels and connective tissue. Complication rates were documented over follow-up.

Results reported

The authors concluded that LigaSure-assisted gland excision in deep plane neck lift was technically easier to perform, time saving, safe, and highly effective in preventing hematoma and intraoperative bleeding.

How to read these results

The paper is classified as therapeutic, level IV evidence: a case series without a comparison group. That makes it a strong description of a technique and its complication profile in experienced hands, and a weaker basis for claims that one method is superior to another. Two points are worth keeping in mind:

• Lower lip weakness still occurred. Seven transient cases in 83 patients is a reminder that nerve proximity, not only bleeding, defines the risk of working in this region.
• Technique sits inside judgement. A sealing device can make the excision step more controlled; it does not decide whether the gland should be touched.

Where this is taught at All About The Neck

The gland runs through both days of All About The Neck, Edition I (Istanbul, 15 and 16 January 2027):

• Day 01, 13:15. Approaching the submandibular gland: assessment, indications and technique, including preservation, support and reduction strategies, conservative partial reduction, vascular control and salivary complications.
• Day 02, 12:00. The submandibular region: anatomical mapping and danger zones, with faculty prosection of the duct and adjacent neural anatomy.
• Day 02, 13:30. Submandibular gland approach and partial reduction: faculty demonstration followed by supervised practice on the specimen.