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Operative Strategies References COMMENTARY 1. Baker DC. Face lift with submandibular gland and digastric muscle resection: radical neck rhytidectomy. Aesthetic Surg J 2006;26:85-92. by Foad Nahai, MD Clinical Editor, Operative Strategies Resection of the submandibular gland to recontour the neck is neither common nor universally accepted.1 My recent review of 100 consecutive face and neck lifts2 indicates that, of 56 subplatysmal procedures, the gland was partially resected in 16 patients only. There was no additional morbidity associated with the gland resection; specifically, there was no hematoma, nerve injury, or dry mouth. However, because submandibular gland resection through the submental approach can be technically challenging, with the possibility of profuse bleeding from vessels within the gland or, theoretically, from branches of the facial artery beyond the gland capsule, other avenues for improving neck contour without gland resection are being explored. I believe it is important to critically evaluate such approaches as presented here by Dr. Sullivan and his co-authors. Dr. Sullivan has already established that the prominence of the submandibular gland in the neck is a result of gland ptosis rather than glandular hypertrophy. Therefore, it seems reasonable to explore methods of correcting this ptosis. Guyuron3 has also been exploring the possibility of reversing gland ptosis through an intraoral approach, placing an “absorbable basket” around the gland. Dr. Sullivan and co-authors have intimate knowledge of the anatomy of the submandibular gland and report on their experience using the intraoral route to resuspend Contouring the Aging Neck With Submandibular Gland Suspension 2. Nahai FR, Nahai F. Are Subplatysmal Procedures in Facial Rejuvenation Safe and Warranted? Review of 100 Cases. Presented at the Annual Meeting of the American Society for Aesthetic Plastic Surgery, Orlando, Florida, April 2006. 3. Guyuron B. Personal communication and presentation at: The New Horizons in Aesthetic Plastic Surgery Symposium, January 2005, Palm Springs, CA. Reprint requests: Foad Nahai, MD, Paces Plastic Surgery, 3200 Downwood Circle, Suite 640, Atlanta, GA 30327. Copyright © 2006 by The American Society for Aesthetic Plastic Surgery, Inc. 1090-820X/$32.00 doi:10.1016/j.asj.2006.07.001 AESTHETIC SURGERY JOURNAL ~ July/August 2006 471 Downloaded from https://academic.oup.com/asj/article/26/4/471/178052 by guest on 04 January 2024 and correct gland ptosis. They discuss their early experience with this “internal suspension” procedure combined with subplatysmal tightening to improve neck contour. Although the procedure is still evolving and their experience, at present, is rather limited, the results are encouraging, and there have been no complications. The potential risks of nerve injuries or bleeding have been almost totally eliminated. While ASJ’s Operative Strategies column typically features well-established procedures that are a mainstay of aesthetic surgery practice, I believe that the early publication of this technique will stimulate the interest in neck contouring through manipulation of the submandibular gland, leading to further advances. Not every patient requires neck recontouring or subplatysmal procedures to achieve a pleasing aesthetic result, and not every surgeon involved in neck rejuvenation or neck contouring will embrace this procedure or incorporate it into his or her practice. ■