The Trending Procedure That Can Restore Your 25-Year-Old Jawline

14.05.2026, 17:18 allure.com

In the race for best facelift, the sleekest neck wins, especially on the internet. Because while a keen eye can appreciate the finer points of a facelift—a subtly lifted cheek or the softening of shadows around the mouth—what tends to elicit the most viral Wow is the jawline in profile: that transcendent shift from saggy to sharp, obtuse to acute. The unveiling of definition that has long been obscured. This has always been true to an extent, but in 2026, optimizing those angles has become something of an extreme sport. We’re not talking about bonesmashing (thank god), but rather submandibular gland reduction—a trimming of the salivary glands that sit under the jawbone. The term is slightly less obvious in its intent, but it’s a plastic surgery technique which is, historically speaking, only slightly less controversial than hammering one’s face in the name of looksmaxxing.

While the procedure was first described in the aesthetic literature in 1987, it was hardly the standard of care back then. “In the past, the perception amongst plastic surgeons was that submandibular gland reduction was a risky operation with a high complication rate,” says T. Gerald O’Daniel, MD, a triple board-certified plastic surgeon and facial plastic surgeon in Louisville, Kentucky. (Such presumptions weren’t based on published data, but there are risks involved, which I’ll get to in a bit.) Even 25 years ago, when Dr. O’Daniel first started reducing glands, only a handful of plastic surgeons were performing the maneuver—and often they were vilified for it. “There were doctors who would stand up at big medical meetings and say that what we were doing was malpractice,” he recalls.

A patient of Dr. O'Daniel before (left) and 8 months after (right) a deep-plane neck and facelift with submandibular gland reduction (plus upper and lower blepharoplasty and fat transfer). Images courtesy of Dr. Gerald O'Daniel.

This happened as recently as 2018, says Dr. O’Daniel. The most passionately opposed argued that cosmetic gland reduction was radical and dangerous, because it involves operating on highly vascular (filled with blood vessels) structures, in a confined space underneath the platysma muscle of the neck. An uncontrolled bleed in this area can obstruct the airway, potentially leading to death.

So why consider it? In certain people, the submandibular glands—as well as the adjacent fat pockets and digastric muscles (which aid in swallowing, chewing, and speech)—can give a look of fullness, blunting the border between the face and neck. (Some are born with large glands; in others, the glands protrude with age.) In such cases, “there’s a limit to how sharp of a jawline I can give them” without treating the impeding glands, explains New York City board-certified plastic surgeon Ira Savetsky, MD. In his experience, when the glands are small and in a more favorable position (tucked up, out of sight, in the floor of the mouth), he can often “resuspend them indirectly” by tightening the platysma over them “to sort of bolster them up.”

While Dr. Savetsky trims patients’ glands selectively, in only about 10 percent of his first-time facelifts and 15 to 20 percent of secondary cases, other surgeons do it routinely, 70, 95, or even 100 percent of the time, believing their patients’ happiness with their results depends on it. (And Dr. Savetsky does say: “I believe the number of patients who could aesthetically benefit from addressing it is higher. However, when I have a thorough discussion—including the inherent risks of the procedure—many patients ultimately choose to decline and accept the limitations of their neck contour.") Then there are those who, as a rule, never touch the glands, insisting that the risks outweigh the benefits. “I’m not saying it’s absolutely the wrong thing to do—it can be done safely, many times in a row, by talented surgeons—but, for me, it’s the wrong thing to do given my risk comfort,” says David Rosenberg, MD, a double board-certified facial plastic surgeon in New York City. His stance isn’t a formal denunciation, however. “This is a personal decision based on the fact that I’ve built a thriving practice, with wonderful outcomes, without taking that added risk.” While he acknowledges that catastrophic bleeds related to the glands are very rare, he adds, “I don’t want to go to sleep at night wondering if something terrible is going to happen.”

The same patient of Dr. O'Daniel before (left) and 8 months after (right) a deep-plane neck and facelift with submandibular gland reduction (plus upper and lower blepharoplasty and fat transfer). Images courtesy of Dr. Gerald O'Daniel.

The fear has been hard to shake. In 2021, when The Aesthetic Society surveyed its members about certain “novel or less mainstream” procedures, 89% said they don’t perform submandibular gland reduction, with most citing “danger to the patient” as the main reason. The majority also reported that they had not learned the procedure in training. Ultimately, the society concluded that “when comparing the perceived complication rates with data published in the literature, particularly when looking at rates of serious or life-threatening complications, plastic surgeons overestimate the risk of procedures with which they are less familiar.”

In 2026, however, gland reduction is gaining ground. For the better part of two decades, Dr. O’Daniel has taught facelift cadaver courses—dissection-focused anatomy labs for surgeons aiming to hone their skills or acquire new ones. For the longest time, he says, very few attendees knew how to treat the glands or expressed any interest in learning. But this past year, when Dr. O’Daniel asked a group of surgeons how many routinely reduce the glands, two-thirds raised their hands—and the rest were eager to learn how to do it safely.

The uptick is being driven by patients who are requesting the procedure. “They often come in knowing more facelift terminology than some plastic surgery residents,” Dr. Savetsky says (not entirely in jest). And they’re “pushing for better and better results,” adds Garrett Locketz, MD, a double board-certified facial plastic surgeon in Denver. The savviest among them have come to realize that “in some people, the submandibular gland is the thing that stands between a good neck and an outstanding neck.”

With esteemed experts sharing conflicting opinions on social, some patients are naturally confused about the merits of gland contouring. “There’s a group of surgeons who are doing this routinely, and they promote it in a way that makes you think if you’re not getting it, you’re going to have a lesser result,” Dr. Rosenberg says. Is there any truth to this?

L. Mike Nayak, MD, seems to think so. “It really just comes down to: How good of a result do you want and what are you willing to do to get it,” says the double board-certified facial plastic surgeon from St. Louis. Going under the platysma to debulk glands and other tissues, as one does in a deep neck lift, demands the utmost proficiency and adds time and risk to the operation, he says, but it typically garners a cleaner, crisper outcome than a traditional neck lift (which tightens muscle, redrapes skin, and perhaps removes some of the fat lining the skin).

“I truly believe there’s no reason for a debate if the question is, Which technique gives a sharper neckline?” adds board-certified San Francisco plastic surgeon Dino Elyassnia, MD, when asked about his peers’ polarizing viewpoints. “There’s a drastic difference in the shape of the neck when you treat the deep layer.”

To understand why, imagine your mandible, or lower jawbone, as a container of sorts. (Trust: Four different surgeons explained gland prominence using this analogy.) In someone with a deep, well-defined jawline, “the gland is completely hidden within the confines of the horseshoe of the mandible,” Dr. Nayak says. But if the gland expands or droops, which is common with age, a portion of it can escape those confines, bulging out below the jawbone and appearing as a lump in the neck. Even if your glands aren’t especially sizable or saggy, they can still show themselves due to bone loss. Inevitably, “the mandible shrinks over time, so the depth of our container is getting smaller,” adds Dr. Nayak. But age isn’t always the instigator: “Some people are born with a small container and/or too much volume, and their necks tend to go straight down,” notes Dr. O’Daniel. In a 2021 study, he found that the majority of volume in the neck is related to the submandibular glands, the digastric muscles, and the deep fat, which can only be accessed and addressed by going under the platysma.

According to Dr. Locketz, there are two types of patients who can usually benefit from gland contouring: Those with genetically rounded or heavy necks, who’ve always had “fullness in the deep neck structures,” and also, conversely, very thin patients, whose necks may display the submandibular glands more prominently. In Dr. Locketz’s practice, these two groups represent 50% of his patients.

Other surgeons say they encounter obvious glands less frequently. When Dr. Rosenberg recently reviewed his last 300 facelifts, “only three had evidently large submandibular glands,” he says. “So, yes, there is a very small percentage who would have a better neck if we [reduced] those glands, but it's just a little too scary for me to contemplate.” In such cases, he’s transparent with patients, explaining that while their neck will look more youthful after surgery, the glands will still be visible. “I put my hands on their face and neck and show them what the outcome will be, and I say, I am not the surgeon to take these [glands] out, if that is important to you.” To be clear, Dr. Rosenberg does perform a version of the deep neck lift (which he describes in this 2025 study). He tailors the deep fat and digastric muscles in 100% of cases, but always avoids the glands. In his experience, “a great facelift lifts the gland up if it’s s