Submandibular Gland Resection in East Asian Patients: An Anatomical and Clinical Series of 240 Cases

Background: Submandibular gland (SMG) prominence can disrupt neck contour, particularly in East Asian patients with limited skeletal support and reduced soft-tissue camouflage. Although concerns regarding deep neck hemorrhage with respiratory compromise, nerve injury, sialocele, and dry mouth have limited broader adoption, selective SMG reduction may be incorporated into deep neck contouring in appropriately selected patients. Methods: We retrospectively reviewed 240 East Asian patients who underwent deep neck contouring with partial SMG resection from August 2024 to July 2025. Concomitant facelift or neck lift procedures were performed when clinically indicated for skin laxity or advanced aging changes. SMG reduction was performed through medial capsular entry and lobule-by-lobule bipolar dissection with targeted cauterization of intraglandular vessels. Thin-film fibrin sealant and low-dose botulinum toxin A were applied to the residual gland for dead-space and secretion control. Outcomes included complications, surgeon-rated Likert scores based on standardized photographs, and patient satisfaction. Results: Observed complications included hematoma in 3 patients (1.3%; reoperation, n = 1), seroma in 3 (1.3%), infection in 2 (0.8%), sialocele in 1 (0.4%), and transient lower-lip depressor dysfunction in 4 (1.7%). No permanent nerve injury or clinically evident salivary dysfunction was observed during follow-up. The single sialocele resolved with aspiration and adjunctive BTX-A injection. Standardized photographic assessment demonstrated consistent improvement in mandibular contour. Conclusions: In this retrospective East Asian cohort, lobule-based SMG reduction was associated with low observed complication rates and favorable contour improvement. Selective SMG reduction may be considered as a component of anatomy-based deep neck contouring in appropriately selected patients. Level of Evidence: Therapeutic, IV.