Dr. Dean Kane Q & A 
Q. 6 months after full facelift, neck lift & platysmaplasty, I can feel firm-ish lumps either side of my neck, but they are not symmetrical. One side feels elongated (horizontally) and the other is round-ish. They feel slightly “nodular”, like firm lumpy jelly, and sometimes tender. They are about an inch either side of the midline and about an inch below the jawline. Where exactly are they positioned, and should they be palpable?
A. By 6 months following surgery including facelift, neck lift and platysmaplasty, most of the swelling and a majority of the scarring including lumps and cords have resolved. You can expect continued improvement for the next 6+ months in softening of the face as the collagen healing goes through remodeling; tenderness and thickened, reddish scars will also normalize.
The lumps you feel about 1 centimeter in diameter are probably the sub-mandibular glands if you feel them up and under the mid-jaw line. They may also be swollen lymph nodes which develop during the healing process of surgery or infection. They are also not symmetrical as they shape to the surrounding structures. As they are salivary glands, they will produce saliva and are enlarged, swollen or inflamed at times depending what you eat. Hardness, particularly on one side only would encourage me to recommend you to a Board Certified ENT surgeon for evaluation.
The sub-mandibular glands are surrounded by a hammock of ligaments, muscles, nerves, arteries and veins. Historically, many attempts have been used to re-suspend the sub-mandibular glands back under the jawline when they have sagged from their youthful location. Most surgeons who perform a neck lift and in particular a platysmaplasty will try to tuck the gland upward with the platysma but placement of a suture in the wrong spot could cause complications neither you nor the surgeon want to risk.
I use a “mattress” or double suspension suture from one side of the platysma to the opposite mastoid fascia superficial to the platysma muscle. This will add strength to the upward elevation of the floor of mouth and help but not guarantee repositioning the glands where they belong.
Another option if it is an issue for you is to discuss with your surgeon or ENT to use Botox and “dry” up the gland but this may lead to a dry mouth and other concerns.
Always return to your primary surgeon or seek the opinion of a Board Certified Plastic Surgeon or facial ENT surgeon.
I hope this helps! All the best!
This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
