Should You Trim Glands During A Neck Lift?

Dr Michael Kernohan MBBS, MSc, BDS, MRCS, FDSRCS, FRCS(Plast), FRACS (Plast

Pros and Cons of Gland Trimming in Neck Lift Surgery

A neck lift, also known as a lower rhytidectomy, is a surgical procedure designed to alter the appearance of your neck by addressing excess, loose skin, excess fat, and muscle banding. However, as techniques evolve, a noteworthy concern has been highlighted: should glands be trimmed during a neck lift?

Sydney Specialist Plastic Surgeon Dr Michael Kernohan has extensive experience in performing a wide range of facial procedures, including facelift, neck lift, brow lift, and blepharoplasty.

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The Anatomy of the Neck

To understand the complexities of a neck lift and the role of gland trimming, you should familiarise yourself with the anatomy of the neck. Your neck is an intricate structure composed of muscles, fat, skin, and glands. The key glands we need to focus on are the submandibular glands, which are pairs of salivary glands located beneath your jaw.

These glands play a role in saliva production, but they can also impact your neck’s appearance. As you age, the skin and muscles in your neck begin to lose their elasticity and tone. This process, along with the effects of gravity, can lead to loose skin and the formation of jowls.

The submandibular glands, which remain relatively constant in size throughout your life, can become more prominent as the surrounding tissues lose volume. In some cases, these glands can create a bulge or fullness in the upper neck area. This is where the question of gland trimming during a neck lift becomes relevant.

The Evolution of Neck lift Procedures

Neck lift procedures have come a long way since their inception in the early 20th century. Initially, these surgeries focused primarily on removing excess skin, with little attention paid to the underlying structures. However, as our understanding of facial anatomy and ageing processes evolve, so did the techniques used in neck lifts.

In the 1960s and 1970s, surgeons began to recognise the importance of addressing the platysma muscle – the thin, sheet-like muscle that covers most of your neck. Techniques were developed to tighten and reposition this muscle, leading to more comprehensive and longer-lasting results.

The 1980s and 1990s saw a shift towards less invasive procedures, with the introduction of liposuction to remove excess fat in the neck area. This allowed for more precise contouring and could be performed with smaller incisions.

As we entered the 21st century, the focus shifted to a more comprehensive approach to neck surgery. Surgeons began to consider all aspects of neck anatomy, including fat distribution, muscle laxity, skin quality, and yes – the role of the submandibular glands.

It was during this period that gland trimming emerged as a technique in neck lift procedures. Pioneering surgeons noticed that in some patients, prominent submandibular glands were contributing to fullness in the upper neck, detracting from the desired contour. They began to explore ways to address this issue, leading to the development of gland trimming techniques.

Today, gland trimming is considered an advanced technique in neck lift surgery. It’s not appropriate for every patient, but in carefully selected cases, it can positively impact the overall result of a neck lift procedure.

What Is Gland Trimming?

Gland trimming, in the context of a neck lift, specifically refers to the partial reduction of the submandibular glands. But what exactly does this entail?

The process involves carefully exposing the submandibular glands through the incisions made for the neck lift procedure. Once exposed, Dr Kernohan assesses the size and position of the glands. If deemed necessary, a portion of the gland is removed, typically from the superficial aspect that contributes to the visible fullness in the neck.

You should know that this is a partial reduction, not a complete removal. The goal is to reduce the gland’s prominence while maintaining its essential function. The amount removed can vary but is usually between 20-40% of the gland’s volume.

The technique requires considerable skill and experience. Dr Kernohan must navigate around important nerves and blood vessels in the area, making precision paramount. Advanced surgical techniques, including the use of specialised instruments and sometimes even endoscopic assistance, may be employed for accuracy and safety.

Potential benefits of gland trimming include:

  • A more defined jawline and neck contour
  • Reduction of fullness in the upper neck area
  • More comprehensive overall results

However, like any surgical procedure, gland trimming comes with potential risks:

  • Temporary or permanent changes in saliva production
  • Nerve injury leading to numbness or weakness in the lower lip or tongue
  • Potential for overcorrection, leading to a hollowed appearance

It’s important to note that these risks are generally low when the procedure is performed by a skilled and experienced plastic surgeon. However, they underscore the importance of thorough consultation and careful patient selection for this technique.

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The Great Debate: To Trim or Not to Trim?

The question of whether to trim submandibular glands during a neck lift has sparked considerable debate within the plastic surgery community. Here are some of the arguments on both sides of this discussion:

Arguments for gland trimming

  • Aesthetic results: Proponents argue that in carefully selected patients, gland trimming can significantly impact the overall outcome of a neck lift. It can create a more defined jawline and a neck contour, addressing an issue that other techniques may not fully resolve.
  • Harmonious results: Supporters believe that addressing all aspects of neck ageing, including prominent glands, leads to more harmonious and balanced results.
  • Patient satisfaction: Some surgeons report high satisfaction rates among patients who have undergone gland trimming, particularly those who were bothered by fullness in the upper neck area.

Arguments against gland trimming

  • Functional concerns: Critics worry about the potential impact on saliva production, arguing that even a partial reduction of the gland could affect its function.
  • Risk vs. benefit: Some surgeons feel that the potential risks, such as nerve injury, outweigh the potential aesthetic benefits for most patients.
  • Alternative options: Opponents argue that other, less invasive techniques can often achieve satisfactory results without the need for gland manipulation.
  • Irreversibility: Unlike some other aspects of a neck lift, gland trimming is not reversible if the patient is unhappy with the result.

The decision to include gland trimming in a neck lift procedure is not one-size-fits-all. Different factors influence whether this technique might be recommended for you:

  • Visible gland prominence: If you have noticeable fullness in the upper neck area that doesn’t respond to other contouring techniques, this may be due to prominent submandibular glands.
  • Thin skin: If you have thin skin in the neck area, your submandibular glands may be more visible, making gland trimming a potential option.
  • Overall neck anatomy: The relationship between your chin projection, neck length, and gland size all play a role in determining whether gland trimming would be beneficial.
  • Previous neck lift results: If you’ve had a previous neck lift but are unsatisfied with fullness remaining in the upper neck, gland trimming might be considered.
  • Aesthetic goals: Your personal goals for the procedure are crucial. If achieving a very defined neck contour is a priority, gland trimming might be discussed.
  • General health: Your overall health and any medical conditions that might affect healing or increase surgical risks will be taken into account.
  • Age: While there’s no strict age limit, the benefits of gland trimming may be more pronounced in younger patients with good skin elasticity.
  • Realistic expectations: It’s essential that you have a clear understanding of what gland trimming can and cannot achieve.

Keep in mind that the recommendation for gland trimming will always be made in the context of your overall neck lift plan. Dr Kernohan will discuss this option with you if he believes it could benefit your results. He makes sure you’re fully informed about the procedure and recovery as well as the potential risks and complications.

Alternative Techniques

While gland trimming can be an effective technique in neck lift surgery, it’s not the only option for addressing neck concerns. Alternative methods can be used, either alone or together, to achieve a more contoured neck appearance:

  • Liposuction: This technique can effectively remove excess fat in the neck and jawline area. It’s less invasive than gland trimming and can significantly change the neck contour in patients whose primary concern is excess fat.
  • Platysma plication: This involves tightening the platysma muscle, which can address muscle banding and positively impact the overall neck contour. It’s a standard part of many neck lift procedures.
  • Skin tightening: Various techniques, from traditional excision to newer laser treatments, can address loose, excess skin in the neck area.
  • Wrinkle Treatments: For some patients, wrinkle treatments can provide temporary changes to the necks appearance, particularly for vertical banding. These treatments will require follow-up sessions to maintain results.
  • Volumising Treatments: In some cases, strategic use of volumising treatments can positively impact the neck contour, particularly along the jawline. However, these treatments will require follow-up sessions to maintain results.
  • Neck exercises: While not a surgical option, certain facial exercises may help tone the neck muscles for some patients.

Compared to gland trimming, these alternatives generally carry less risks and are not as invasive as necklift surgery. However, they may not address the specific issue of prominent submandibular glands. The choice between gland trimming and these alternatives depends on your individual anatomy, concerns, and desired outcomes.

Dr Kernohan will assess your unique situation and may recommend one or several of these techniques to achieve optimal results.

FAQs about Gland Trimming during Neck Lift Surgery

FAQs

Will gland trimming affect my ability to produce saliva?

  • Gland trimming involves a partial reduction of the submandibular glands, typically removing 20-40% of the gland. Most patients do not experience significant changes in saliva production. However, some may notice a temporary reduction in saliva, which usually resolves as the remaining gland tissue compensates.

How long does it take to recover from a neck lift with gland trimming?

  • Recovery time can vary, but most patients can return to light activities within 1-2 weeks. Full recovery may take 4-6 weeks. Dr Kernohan will provide you with detailed post-operative instructions to optimise healing.

Will I have visible scars from gland trimming?

  • Gland trimming is typically performed through the same incisions used for your neck lift, which are strategically placed to be as inconspicuous as possible.

Can gland trimming be reversed if I’m not happy with the results?

  • Gland trimming is not reversible, which is why patient selection and thorough pre-operative discussions are crucial.

Are there non-surgical alternatives to gland trimming?

  • While there are non-surgical treatments that can change overall neck appearance (such as wrinkle and volumising treatments), these typically cannot address prominent submandibular glands as effectively as surgical trimming.

How long do the results of gland trimming last?

  • The results of gland trimming are generally long-lasting. However, it’s important to remember that your neck will continue to age over time.

Will I need to take time off work for a neck lift with gland trimming?

  • Most patients take 1-2 weeks off work, depending on their job requirements. Dr Kernohan will advise you based on your specific situation and procedure.

Is gland trimming painful?

  • You’ll be under anaesthesia during the procedure, so you won’t feel any pain.
  • Post-operative discomfort is usually well-managed with prescribed pain medication.

How do I know if I’m a good candidate for gland trimming?

  • The best way to determine if you’re a suitable candidate for gland trimming is through a consultation with Dr Kernohan. He will assess your anatomy, discuss your goals, and recommend the most appropriate treatment plan for you.

Further Reading about Face Procedures with Sydney Specialist Plastic Surgeon Dr Michael Kernohan

Medical References for Neck Lift Surgery