Cervical Technique
Deep Neck Without Gland Removal
Comprehensive cervical rejuvenation that preserves the submandibular gland — achieving excellent results without the hollowing that aggressive approaches can create.
A conservative philosophy applied to neck surgery: address what needs addressing, preserve what should be preserved. The result is natural-looking neck definition with lower complication risk.
"The submandibular gland exists for a reason. Removing it creates problems we then have to solve. Better to work with the anatomy, not against it."
— Dr. Robério Brandão
Why Preserve the Submandibular Gland?
Some neck lift techniques advocate for submandibular gland removal (submandibular gland excision) to achieve a more defined cervicomental angle. While this can produce dramatic initial results, it comes with significant trade-offs that Dr. Brandão's approach avoids.
Problems with Gland Removal
- Hollowing: The gland occupies volume in the submandibular triangle. Removing it can create an unnatural hollow appearance, especially as patients age and lose additional volume.
- Dry mouth risk: The submandibular gland contributes significantly to saliva production. Removal can cause xerostomia (dry mouth) in some patients.
- Marginal nerve risk: The marginal mandibular branch of the facial nerve runs in close proximity to the gland. Gland removal increases manipulation near this nerve.
- Irreversibility: Unlike other aspects of neck surgery, gland removal cannot be undone. If the aesthetic result is poor, there's no way to restore the volume.
The Conservative Alternative
Dr. Brandão's Deep Neck technique achieves excellent neck definition through:
- Platysmorraphy: Precise plication (folding and suturing) of the platysma muscle to recreate the cervicomental angle
- Fat management: Selective lipectomy of submental and subplatysmal fat when indicated
- Digastric attention: When the digastric muscle contributes to fullness, careful shaving can improve contour without functional compromise
- Glandular loop: Creating a "sling" that repositions rather than removes the gland
The result is a defined neck without the risks of gland removal — and without the unnatural hollowing that can occur years later.
Technical Components
Gland Preservation
The submandibular gland is preserved, avoiding the hollow appearance that can result from gland removal and reducing complication risk.
Platysmorraphy
Precise platysmal muscle plication to recreate the cervicomental angle and address platysmal bands without excessive tension.
Digastric Shaving
When indicated, careful digastric muscle management to improve submental contour while respecting functional anatomy.
Direct Vision Access
Clear visualization through submental approach allows safe navigation of the complex cervical anatomy with its vessels and nerves.
Patient Selection
check_circle Ideal Candidates
- • Platysmal banding (vertical neck bands)
- • Submental fullness ("double chin")
- • Loss of cervicomental angle definition
- • Neck skin laxity (moderate)
- • Combined with ENDOMIDFACE® for full face
- • Age 45-70 (typical range)
cancel Consider Alternatives When
- • Severe skin excess requiring excision
- • Prior neck surgery with scarring
- • Unrealistic expectations
- • Primary concern is jowl (may need facelift)
- • Significant weight fluctuation expected
Detailed selection criteria: Indications & Patient Selection
Combined with ENDOMIDFACE®
Deep Neck is often performed in conjunction with ENDOMIDFACE® by Direct Vision for comprehensive facial rejuvenation. The techniques share the same philosophical approach — Direct Vision, conservative tissue handling, and respect for natural anatomy.
When combined, patients receive full facial treatment: midface elevation, jowl improvement, and neck definition in a single surgical session.
Learn both techniques: Combo Legacy Program arrow_forwardExplore Deep Neck in Detail
Master Deep Neck Surgery
The 2-month Deep Neck mentorship includes comprehensive training in cervical anatomy, platysmorraphy techniques, and complication management.