Submandibular Gland Reduction in the Modern Necklift Surgery: A Systematic Literature Review

Submandibular gland prominence can undermine aesthetic outcomes in neck and lower face rejuvenation, even after deep-plane facelifts and platysmaplasty. In selected patients, gland reduction has emerged as an effective adjunct to improve cervicomental contour. In this systematic review, the authors analyze 51 studies involving 2971 patients undergoing submandibular gland reduction across 6 surgical approaches, including transcervical, necklift-integrated, intraoral, retroauricular, endoscopic, and robotic-assisted techniques. The overall complication rate was 15.1%, with marginal mandibular nerve injury being most common (9.8%). Minimally invasive methods, particularly endoscopic and intraoral, showed lower hematoma rates and faster recovery with high patient satisfaction. Retroauricular approaches yielded excellent aesthetic outcomes but had the highest nerve injury rates. LigaSure-assisted and partial reductions reduced bleeding and preserved function. Despite generally favorable results, variation in technique, outcome reporting, and patient selection limits broader adoption. Standardized protocols and prospective studies are needed to optimize safety, aesthetic benefit, and long-term results in submandibular gland contouring for facial rejuvenation. Level of Evidence: 3 (Therapeutic).