Salivary Gland Hypertrophy Treatment: Submandibular Gland Surgery with Neck Lift

Botox for Salivary Glands Is Common—But What About Gland Removal Surgery?

While many are familiar with botox injections for salivary gland reduction, submandibular gland removal surgery is far less common—even among plastic surgery clinics in Gangnam.

Interestingly, Dr. Connell, a pioneer in facelift surgery, has emphasized the value of submandibular gland removal for facelift for over 30 years. Despite its proven benefits, the high level of surgical difficulty makes it rare, especially for aesthetic purposes.

In this article, we compare botox injection and surgical options for salivary gland hypertrophy treatment.

What Are the Main Types of Salivary Glands?

The face contains three major salivary glands:

Parotid gland

Located behind the jaw and under the ear; largest and most important for saliva production

Submandibular gland

Beneath the jaw; often targeted for reduction due to its location and lower functional importance

Sublingual gland

Under the tongue; smallest

💡 TIP: Removal of the submandibular gland rarely causes dry mouth, as it's not the major contributor to saliva.

Why treat the Submandibular Gland?

A beautiful neck, as shown in the image above, depends on a well-defined mandibular line (1) and a sharp angle between the neck and submentum (4). When the submandibular gland protrudes, it can interfere with achieving this ideal contour.

Two Approaches to Treat Salivary Gland Hypertrophy

1. Botox Injection

• ✅ Pros: Simple procedure, minimal downtime
• ❌ Cons: Temporary results; requires repeat treatments
• ⚠️ Caution: Precise anatomical knowledge is crucial for effective injection and avoiding nearby vessels

2. Submandibular Gland Surgery

• ✅ Pros: Permanent reduction; excellent synergy with neck lift or double chin liposuction
• ❌ Cons: Technically demanding; limited number of clinics offer it
• 🔍 Note: Surgery allows direct visualization and precise reduction

Is It Safe to Remove the Salivary Gland?

Many patients ask: “Is it functionally safe to remove the submandibular gland?”

The answer is yes—as long as it's performed by an experienced Korean Plastic Surgeon. Since other glands compensate and the submandibular gland plays a secondary role, functional impairment is rare.

Why Combine Neck Lift with Gland Reduction?

For patients over 30, skin elasticity begins to decline. Removing the gland alone may cause the overlying skin to sag like a deflated balloon.

Combining gland removal with muscle tightening (platysmaplasty) and neck lifting ensures a more contoured and natural jawline.

What Happens If You Skip Gland Removal in Neck Lift?

Three possible scenarios can occur.

The gland becomes more visible 

After fat is removed from the double chin area, prominence of gland can be more visible.

It’s especially visible when tilting the head down

While looking down, the muscle relaxes and gland can be seen easily.

Patients often ask, “What is this lump after surgery?”

If the gland is not reduced during the neck lift, patients often notice a visible bulge or “pop-up” under the neck.

Potential Risks of Submandibular Gland Surgery

1. Bleeding

• The area is rich in blood vessels. Even needling with local anesthesia can cause bleeding. Experience is critical.

2. Salivary Cyst (sialocele)

• Post-op saliva may pool, forming a cyst. Usually temporary and manageable with dietary modification and botox.

3. Nerve Damage

• The marginal mandibular nerve lies nearby. Real-time nerve monitoring during surgery can reduce this risk.

Is the Procedure Covered by Insurance?

Unfortunately, cosmetic gland removal is not covered by health insurance unless it's for tumor removal or medical necessity.

Is Gland Removal Common Internationally?

Globally, only a few surgeons perform submandibular gland removal for cosmetic reasons due to its complexity. However, its necessity is gaining recognition in medical literature, including publications like Clinics in Plastic Surgery.

Noonopi’s Mini Neck Lift Protocol

At Noonopi Plastic Surgery, our mini neck lift includes:

• Deep fat removal
• Gland reduction or removal
• Digastric muscle trimming
• Platysma muscle tightening

❗Note: We don’t remove excess skin in mini neck lifts, because improving contour often increases the need for skin surface area—not less.

How Much Tissue Should Be Removed?

There is no fixed rule. Like a sculptor working with clay, surgeons must assess and tailor the removal based on real-time anatomy during surgery.

Who Is a Good Candidate for Mini Neck Lift + Gland Reduction?

Ideal for patients in their 40s or younger with minimal skin laxity.
For significant sagging, a traditional neck lift with skin excision behind the ears may be more appropriate(see the below video)