One of the adverse aesthetic side effects of any form of jaw angle surgery is that of masseteric muscle dehiscence. Because it is most commonly associated with implant placements (jaw angle and/or custom jawline implants) it is also known as ‘implant reveal’. It becomes most manifest in this aesthetic clinical situation because of the expanded bony contours.
Masseteric muscle dehiscence creates a soft tissue contour deformity over the bony/implant jaw angle.This can be due to either muscle retraction from loss of attachment or expansion of the jaw angle structure beyond where the muscle can stretch over it. While there is no functional significance to this change in muscle length (origin to insertion length), the aesthetic relevance depends on how significant the contour deformity is.
For those patients bothered by the contour deformity the logical approach is to try and reposition the muscle back over the bone/implant. While the concept is straightforward doing so is far more difficult than it may seem. The biggest challenge is incisional access to try the muscle repositioning surgery and to do so leaving an acceptable scar. It is important to avoid creating another aesthetic issue that the patient may perceive as just as significant as the one being solved.
The most common incisional location is high up in the neck below the jaw angle or just right behind the jaw angle. While these are effective access incisions, other options are available. In a patient who is undergoing a facelift, the skin flap raised from around the ear can be lifted up for access to the jaw angle area.
From this access the masseter muscle can be elevated from the bone and efforts made to get enough laxity of it to bring it back over the angle implant. The implant material provides a form place hat will support suture fixation.
The facelift incision is not the workhorse method to treat masseteric muscle dehiscence. But if the combination of a facelift and massesteric muscle dehiscence does exist it does provide enough access to effectively perform the procedure.
Dr. Barry Eppley