The neck is one of the most challenging regions in facial surgery. Elegant cervical contour requires work on multiple structures: skin, fat, platysma muscle, subplatysmal fat and, frequently, submandibular gland. Historically, some surgeons proposed submandibular gland removal to create more defined contours. The Modern Face Deep Neck technique demonstrates this is unnecessary — and risky.
“Removing functional gland for aesthetics is like using cannon to kill fly. There are more elegant ways to solve problem.”
- — Dr. Robério Brandão
Why Not Remove Submandibular Gland?
⚠️ Gland Removal Risks
• Marginal Mandibular Nerve Injury Causes lower lip paralysis — smile asymmetry. May be permanent.
• Xerostomia (Dry Mouth) Submandibular gland produces 70% of resting saliva. Bilateral removal causes significant discomfort.
• Swallowing Difficulty Saliva is essential to form food bolus. Patients may have dysphagia.
• Seroma and Salivary Fistula Postoperative complications that may require reoperation.
• Contour Depression Removal can create “hole” in cervical contour over time. These risks aren’t justifiable when techniques exist that deliver equivalent or superior results without removing functional tissue.
Modern Face Approach: Preserve and Reposition Modern Face Deep Neck uses set of techniques that create elegant cervical contour without removing functional structures: 01
Platysmaplasty
Suturing of platysma muscle medial borders at midline. Creates muscular “corset” that defines cervicomental angle. Benefit: Lasting support, cervical angle definition, platysmal bands correction. 02
Glandular Sling
Sutures passed around submandibular gland, repositioning it superiorly and medially. Gland is “suspended” in more favorable position. Benefit: Mandibular angle contour improvement without removing functional tissue. 03
Digastric Shaving
Controlled thinning of digastric muscle anterior belly. Reduces excess muscle volume that can compromise submental contour. Benefit: Submental profile improvement without compromising muscle function. 04
Lateral Crevassi
Release and repositioning of lateral neck structures through specific access, allowing vertical tissue traction. Benefit: Lateral cervical and mandibular contour definition. 05
Selective Lipectomy
Removal of supraplatysmal and subplatysmal fat in adequate amount. Not excessive (avoids skeletal aspect) nor insufficient. Benefit: Natural definition, without hollowing or residual excess.
Comparison: Removal vs. Preservation
Aspect Gland Removal Preservation (Modern Face)
Marginal Nerve Risk High (mandatory proximity) Low (preserved distance)
Xerostomia Significant risk No risk
Long-term Contour Depression risk Stable
Surgical Time Longer Moderate
Recovery More prolonged Faster
Aesthetic Result Good (when no complications) Excellent
Frequently Asked Questions
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