Commentary

Resection of the submandibular gland to recontour the neck is neither common nor universally accepted.¹ My recent review of 100 consecutive face and neck lifts² indicates that, of 56 subplatysmal procedures, the gland was partially resected in 16 patients only. There was no additional morbidity associated with the gland resection; specifically, there was no hematoma, nerve injury, or dry mouth. However, because submandibular gland resection through the submental approach can be technically challenging, with the possibility of profuse bleeding from vessels within the gland or, theoretically, from branches of the facial artery beyond the gland capsule, other avenues for improving neck contour without gland resection are being explored. I believe it is important to critically evaluate such approaches as presented here by Dr. Sullivan and his co-authors.

Dr. Sullivan has already established that the prominence of the submandibular gland in the neck is a result of gland ptosis rather than glandular hypertrophy. Therefore, it seems reasonable to explore methods of correcting this ptosis. Guyuron³ has also been exploring the possibility of reversing gland ptosis through an intraoral approach, placing an “absorbable basket” around the gland.

Dr. Sullivan and co-authors have intimate knowledge of the anatomy of the submandibular gland and report on their experience using the intraoral route to resuspend and correct gland ptosis. They discuss their early experience with this “internal suspension” procedure combined with subplatysmal tightening to improve neck contour. Although the procedure is still evolving and their experience, at present, is rather limited, the results are encouraging, and there have been no complications. The potential risks of nerve injuries or bleeding have been almost totally eliminated.

While ASJ's Operative Strategies column typically features well-established procedures that are a mainstay of aesthetic surgery practice, I believe that the early publication of this technique will stimulate the interest in neck contouring through manipulation of the submandibular gland, leading to further advances. Not every patient requires neck recontouring or subplatysmal procedures to achieve a pleasing aesthetic result, and not every surgeon involved in neck rejuvenation or neck contouring will embrace this procedure or incorporate it into his or her practice.

References