Introduction: The Neck Challenge The neck is often called the “age tell-tale”. While the face can be rejuvenated with fillers and non-invasive treatments, the neck resists: platysmal bands, submental fat and deep structure ptosis do not respond to superficial treatments. Deep Neck (deep necklift) emerged as an answer to this challenge. Unlike traditional cervical lifting that works only on the skin and superficial SMAS, Deep Neck addresses the deep structures responsible for cervical aging: platysma, subplatysmal fat, digastric muscle and submandibular gland. However, many Deep Neck techniques include submandibular gland removal — a procedure that, although aesthetically effective, carries significant risks of xerostomia (dry mouth) and nerve injury.
“The art of Deep Neck is achieving maximum cervical definition without sacrificing functional structures. The submandibular gland doesn’t need to be removed — it needs to be repositioned.”
- — Dr. Robério Brandão This article presents the Modern Face Deep Neck approach: a deep cervical rejuvenation technique that preserves the submandibular gland through the Glandular Loop, achieving equivalent aesthetic results with a superior safety profile.
Relevant Anatomy for Deep Neck
To safely perform Deep Neck, the surgeon must master the anatomy of deep cervical structures:
Cervical Layers (Superficial → Deep)
1 Skin: Thin and mobile in the cervical region
2 Subcutaneous fat: Variable, target of initial liposuction
3 Platysma: Thin muscle that forms visible “bands” with aging
4 Subplatysmal fat: Deep accumulation to the platysma, not accessible by conventional liposuction
5 Digastric muscle: Anterior belly can be hypertrophic, causing fullness
6 Submandibular gland: Can prolapse inferiorly with aging
At-Risk Structures
Marginal Mandibular Nerve
Facial nerve branch that innervates lower lip depressors. Injury causes smile asymmetry. Crosses mandible ~2cm posterior to angle.
Lingual Nerve
Risk during submandibular gland removal. Injury causes hemitongue anesthesia. Preserved in Glandular Loop technique.
External Jugular Vein
Superficial to platysma. Must be identified and preserved or properly ligated during dissection.
Wharton’s Duct
Submandibular gland duct. Injury causes sialocele or salivary fistula. Preserved with Glandular Loop technique.
The Four Pillars of Modern Face Deep Neck The Modern Face Deep Neck technique is structured on four main maneuvers, each addressing a specific component of cervical aging:
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Operative Sequence
Markings and Infiltration
Marking of platysmal bands, liposuction area and submental incision. Tumescent infiltration. 2.
Initial Liposuction
Removal of subcutaneous and pre-platysmal fat. Defines subsequent dissection plane. 3.
Incision and Exposure
Submental incision of ~3-4cm. Dissection until visualizing medial edges of platysma. 4.
Platysmaplasty
Suture of medial edges of platysma with interrupted nylon or PDS stitches. Recreates cervicomental angle. 5.
Subplatysmal Fat
Direct resection of fat deep to platysma. Direct visualization allows precision. 6.
Digastric Shaving
If indicated, reduction of hypertrophic anterior belly with electrocautery. Preserves insertion and function. 7.
Glandular Loop
If necessary, retention suture to reposition prolapsed submandibular gland. WITHOUT removal. 8.
Closure and Dressing
Layered closure. Cervical compression garment. Postoperative instructions.
Why NOT Remove the Submandibular Gland? Submandibular gland excision is advocated by some authors for maximum mandibular contour definition. However, this approach carries risks that we consider unnecessary:
Complication Incidence Consequence
Xerostomia 10-30% Permanent dry mouth, difficulty swallowing
Marginal nerve injury 2-5% Smile asymmetry, lip weakness
Lingual nerve injury 1-3% Hemitongue anesthesia, dysgeusia
Salivary fistula 2-5% Saliva drainage through incision
Hematoma 5-10% Bleeding in glandular bed
The Glandular Loop technique achieves comparable aesthetic result (superior repositioning of the gland) without the risks associated with removal. The gland remains functional, the duct intact, and the nerves protected.
✅ Advantages of Glandular Preservation
- • Zero risk of permanent xerostomia
- • Lower risk of nerve injury
- • Faster procedure
- • More predictable recovery
- • Equivalent aesthetic result
Indications and Contraindications
Indications
- ✓ Visible platysmal bands
- ✓ Resistant submental fat
- ✓ Loss of cervicomental angle
- ✓ Subplatysmal fullness
- ✓ Submandibular gland ptosis
- ✓ Patients 45-70 years old
- ✓ Desire for lasting result
Contraindications
- ✗ Severe skin excess (needs traditional lifting)
- ✗ Uncontrolled coagulopathies
- ✗ Unrealistic expectations
- ✗ BMI 35 (limited result)
- ✗ Active smoking
- ✗ Active cervical infection
Frequently Asked Questions
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Master the Deep Neck Technique
2-month mentorship with Dr. Robério Brandão. Platysmaplasty, Digastric Shaving and Glandular Loop.
Deep Neck Mentorship
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Related Articles
Gland Preservation
Technical details on the Glandular Sling.
Cervical Angle
The anatomy of a youthful neck contour.
Endomidface Guide
Combining neck lift with midface rejuvenation.
For surgeons: Learn the Deep Neck technique in our Mastery program.