The fear has been hard to shake. In 2021, when The Aesthetic Society surveyed its members about certain “novel or less mainstream” procedures, 89% said they don’t perform submandibular gland reduction, with most citing “danger to the patient” as the main reason. The majority also reported that they had not learned the procedure in training. Ultimately, the society concluded that “when comparing the perceived complication rates with data published in the literature, particularly when looking at rates of serious or life-threatening complications, plastic surgeons overestimate the risk of procedures with which they are less familiar.”
In 2026, however, gland reduction is gaining ground. For the better part of two decades, Dr. O’Daniel has taught facelift cadaver courses—dissection-focused anatomy labs for surgeons aiming to hone their skills or acquire new ones. For the longest time, he says, very few attendees knew how to treat the glands or expressed any interest in learning. But this past year, when Dr. O’Daniel asked a group of surgeons how many routinely reduce the glands, two-thirds raised their hands—and the rest were eager to learn how to do it safely.
The uptick is being driven by patients who are requesting the procedure. “They often come in knowing more facelift terminology than some plastic surgery residents,” Dr. Savetsky says (not entirely in jest). And they’re “pushing for better and better results,” adds Garrett Locketz, MD, a double board-certified facial plastic surgeon in Denver. The savviest among them have come to realize that “in some people, the submandibular gland is the thing that stands between a good neck and an outstanding neck.”
Why some plastic surgeons treat the glands and others do not
With esteemed experts sharing conflicting opinions on social, some patients are naturally confused about the merits of gland contouring. “There’s a group of surgeons who are doing this routinely, and they promote it in a way that makes you think if you’re not getting it, you’re going to have a lesser result,” Dr. Rosenberg says. Is there any truth to this?
L. Mike Nayak, MD, seems to think so. “It really just comes down to: How good of a result do you want and what are you willing to do to get it,” says the double board-certified facial plastic surgeon from St. Louis. Going under the platysma to debulk glands and other tissues, as one does in a deep neck lift, demands the utmost proficiency and adds time and risk to the operation, he says, but it typically garners a cleaner, crisper outcome than a traditional neck lift (which tightens muscle, redrapes skin, and perhaps removes some of the fat lining the skin).
“I truly believe there’s no reason for a debate if the question is, Which technique gives a sharper neckline?” adds board-certified San Francisco plastic surgeon Dino Elyassnia, MD, when asked about his peers’ polarizing viewpoints. “There’s a drastic difference in the shape of the neck when you treat the deep layer.”
To understand why, imagine your mandible, or lower jawbone, as a container of sorts. (Trust: Four different surgeons explained gland prominence using this analogy.) In someone with a deep, well-defined jawline, “the gland is completely hidden within the confines of the horseshoe of the mandible,” Dr. Nayak says. But if the gland expands or droops, which is common with age, a portion of it can escape those confines, bulging out below the jawbone and appearing as a lump in the neck. Even if your glands aren’t especially sizable or saggy, they can still show themselves due to bone loss. Inevitably, “the mandible shrinks over time, so the depth of our container is getting smaller,” adds Dr. Nayak. But age isn’t always the instigator: “Some people are born with a small container and/or too much volume, and their necks tend to go straight down,” notes Dr. O’Daniel. In a 2021 study, he found that the majority of volume in the neck is related to the submandibular glands, the digastric muscles, and the deep fat, which can only be accessed and addressed by going under the platysma.
