How does salivary gland removal differ from salivary gland Botox?
Appropriate treatment and outcomes may vary with gland location and size, salivary function, and the condition of fat and muscles beneath the chin.
A specific treatment plan must be determined through medical examination and thorough consultation.
Salivary gland Botox or removal is sometimes discussed when fullness appears beneath the chin or ears.
Both target salivary glands, but differ clearly in mechanism, treatment sites, duration, recovery, and possible adverse effects.
Salivary gland Botox is a nonsurgical method that temporarily reduces saliva production by injecting botulinum toxin into a gland.
Cosmetic salivary gland removal, by contrast, generally means excising or reducing a protruding part of the submandibular gland beneath the jaw.
In this article, 'salivary gland removal' means cosmetic partial submandibular gland excision or reduction. Its purpose and extent may differ from removing the entire gland to treat salivary gland disease.
Where are the salivary glands?
The major salivary glands of the face and neck are the parotid, submandibular, and sublingual glands.
- The parotid glands lie in front of and below the ears.
- The submandibular glands lie beneath the jaw, on the inner side of the mandible.
- The sublingual glands lie beneath the tongue.
Botox for the glands below the ears generally targets the parotid glands, while treatment for fullness beneath the jaw may target the submandibular glands.
Cosmetic salivary gland removal in plastic surgery mainly refers to reducing a protruding portion of the submandibular gland. It does not mean removing every salivary gland; the actual extent may vary with gland size, protrusion, and surrounding tissue condition.
How does salivary gland Botox work?
Botulinum toxin injected into a salivary gland temporarily inhibits nerve signals involved in saliva production, reducing the amount of saliva secreted.
In some individuals, reduced gland prominence may make the contour beneath the jaw or ears less noticeable, but the cosmetic change varies with gland location and size, injection site, product, and dose.
Medical research on salivary gland botulinum toxin injections has mainly involved patients with chronic drooling from neurological or other conditions. Findings on reduced saliva production therefore cannot be directly applied to cosmetic jawline improvement.
The effect is also not permanent. As nerve function recovers over time, salivary function may return and repeat treatment may be considered as needed. Duration varies with product, dose, injection site, and individual response.
Is precise localization important for submandibular gland Botox?
Submandibular gland size and location vary between individuals, with muscles, blood vessels, and other structures nearby.
Spread of botulinum toxin into adjacent muscles rather than the gland may cause swallowing discomfort or other problems. Ultrasound localization during injection may therefore be used when needed.
Ultrasound guidance can help visualize gland location and size and select the injection site. However, it cannot prevent every adverse effect; appropriate patient selection and dosing are also important.
What does cosmetic salivary gland removal involve?
It involves excising or reducing part of a prominent submandibular gland to refine the contour beneath the jaw and in the neck. 'Partial submandibular gland excision' or 'submandibular gland reduction' is medically more precise.
The submandibular glands lie deeper than fat beneath the chin. If they protrude downward, fullness on either side beneath the jaw may remain even after liposuction removes fat.
However, not all fullness beneath the jaw is caused by the glands. The following factors contribute to this contour.
- Skin and subcutaneous fat
- Deep fat beneath the platysma
- Loose or separated platysma muscles
- Chin size and position
- Anatomical position of the mandible and hyoid bone
- Submandibular gland size and protrusion
Before deciding on gland removal, it is therefore necessary to distinguish fat-related volume, muscle or skin sagging, and true gland protrusion.
Cosmetic partial submandibular gland excision is not a routine step in every operation beneath the chin or neck lift. It should be selected selectively after comparing actual gland prominence, expected contour changes, and surgical risks.
How do removal and salivary gland Botox differ?
Category / Salivary gland Botox / Cosmetic partial submandibular gland excision or reduction
Treatment / Botulinum toxin injection into a gland / Surgical reduction of part of the protruding gland tissue
Mechanism / Temporary inhibition of nerve signals for saliva production / Direct reduction of actual gland tissue volume
Incision / No incision / Surgical access required
Nature of effect / Temporary and individually variable / Removed tissue does not return simply because a drug effect wears off as with Botox, but overall contour remains affected by aging and surrounding tissue changes
Recovery / Generally less recovery burden than surgery / Recovery from swelling, bruising, pain, and other postoperative effects
Main risks / Dry mouth, thick saliva, injection-site pain and bruising, swallowing discomfort / Bleeding, hematoma, saliva collection, salivary leakage, nerve injury, altered sensation, asymmetry, dry mouth
Suitability / Gland location, size, and salivary function considered / Comprehensive assessment of gland protrusion and overall anatomy beneath the jaw
Surgically removed submandibular gland tissue does not return to its original state after a set period in the way that botulinum toxin effects wear off.
- However, overall contour beneath the jaw may change with the remaining gland and surrounding tissue, skin aging, and weight changes.
When salivary gland Botox may be considered
It may be considered by people who do not want surgery or are concerned about incisions and recovery.
However, substantial structural gland protrusion may not show the expected contour improvement with Botox alone.
Repeated Botox also does not produce the same change as directly excising gland tissue.
If fat, skin sagging, or the platysma is the main source of volume, jawline change from salivary gland Botox may be limited.
When partial submandibular gland excision may be considered
It may be considered when actual downward gland protrusion obscures the contour beneath the jaw and in the neck.
It is sometimes considered together with a neck lift or surgery beneath the chin, particularly when gland protrusion is expected to remain after correction of fat or the platysma.
However, this differs from simple liposuction. Important blood vessels, nerves, and salivary ducts surround the gland, requiring thorough anatomical understanding and meticulous bleeding control.
A literature review of cosmetic submandibular gland excision published in 2025 reported possible complications including hematoma, saliva collection, salivary fistula, nerve injury, dry mouth, and neck firmness.
Because surgical methods and complication reporting criteria vary between studies, published rates cannot be applied equally to all patients.
This is therefore not an operation routinely chosen simply to make the jawline slimmer. Expected changes must be weighed against possible bleeding, salivary leakage, nerve injury, and other risks.
Can Botox or gland removal cause dry mouth?
Saliva protects oral mucosa and helps chewing and swallowing. It also washes away food debris and helps prevent tooth decay and oral infection.
Salivary gland Botox reduces saliva production and may therefore cause dry mouth or thick saliva. Rare swallowing discomfort must also be considered.
Partial submandibular gland excision reduces only part of the protruding gland, while the remaining gland and other salivary glands continue functioning.
Persistent dry mouth is not commonly reported after cosmetic partial excision in the literature, but its possibility is not zero.
More careful assessment is needed with existing dry mouth, salivary function disorders such as Sjögren's syndrome, previous head and neck radiotherapy, or medications that may reduce saliva production.
Which is better: removal or salivary gland Botox?
Neither method can be described as better for every patient.
Botox requires no incision and has a relatively smaller recovery burden, but its effects are temporary and cosmetic changes may be limited.
Partial gland excision directly reduces protruding tissue volume but requires consideration of recovery and risks including bleeding, hematoma, salivary leakage, and nerve injury.
The priority is to establish whether the fullness actually comes from the submandibular gland. If fat, skin sagging, the platysma, or jaw structure is mistaken for gland protrusion, gland treatment may not achieve the expected result.
Suitable treatment should therefore follow assessment of the skin, fat, platysma, submandibular glands, chin, and mandible together, rather than gland size alone.
For questions about which approach may suit you, contact 02-545-3700 or 'UVOM Plastic Surgery' on KakaoTalk.