Redefining the Posterior Jawline: Anatomical Principles and Clinical Outcomes of Parotid Reduction in Aesthetic Neck Contouring-A Retrospective Case Series.

BACKGROUND

Posterior cervicomandibular line effacement and a shallow retromandibular groove can persist after standard neck-lift maneuvers. In selected patients, the parotid tail volume represents a deep-volume contributor that is not reliably addressed with subcutaneous fat reduction or platysmal modification alone. This retrospective case series evaluated anatomical principles, clinical outcomes, and complication profiles associated with adjunctive parotid reduction in aesthetic neck contouring.

METHODS

Consecutive patients undergoing combined face-neck or isolated neck rejuvenation by a single surgeon between January 2022 and March 2024 were retrospectively reviewed after exclusion of non-aesthetic causes of parotid enlargement. Patients with < 6 months of follow-up or irregular postoperative visits were excluded. The primary outcome was blinded photographic improvement at ≥ 6 months, using GAIS (1 = very much improved to 5 = worse), scored independently by two non-involved plastic surgeons. Interrater reliability was assessed using the intraclass correlation coefficient (ICC). Postoperative complications were captured as secondary outcomes.

RESULTS

Fifty-nine patients underwent parotid reduction (53 women, 6 men; mean age 56 ± 9.1 years; BMI 28.4 ± 4.2 kg/m2) with a mean follow-up of 11.7 ± 5.9 months. Mean GAIS was 1.7 ± 0.7 and 2.0 ± 0.9 for both raters, yielding a final mean of 1.8 ± 0.7; all patients were rated at least "improved," and 66% were rated "much" or "very much improved." Interrater agreement was good (ICC = 0.63). Overall, 15.3% experienced ≥ 1 complication, predominantly minor and managed conservatively; one hematoma required operative evacuation, and no permanent sequelae were observed.

CONCLUSION

In selected aesthetic patients, limited, superficial parotid tail debulking through a sub-SMAS corridor may help refine the posterior jawline-neck transition with acceptable morbidity.

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