Can masseter muscle removal damage SMAS?

Question

I want to reduce my masseter muscle, but I’m wondering if it could hurt SMAS in the process? I want to do a face lift after this, so I don’t want to damage my SMAS.

Jacob Tower, MD · Answer

Hello, hope you are well. The answer to your question depends on how masseter 'removal' or 'reduction' will be accomplished. As always, the devil is in the details. The most straightforward way to reduce the masseter is with botulinum toxin injections (Botox, Xeomin, Dysport, etc)--this causes gradual atrophy of the muscle which allows it to shrink down with no incisions or down time. That's a safe way to preserve the SMAS and accomplish your goal. Although I wouldn't necessarily recommend it, if a surgical reduction is proposed, it could theoretically be done transorally (through the mouth) without violating the SMAS in the process. A transfacial approach could also be done theoretically, but it would violate the SMAS and put the facial nerve at higher risk (definitely not recommended given the alternatives). 
Best,Dr. Tower

Can masseter muscle removal damage SMAS?

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Can masseter muscle removal damage SMAS?

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