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Facial Reduction with Massseter Muscle and Buccl Fat Partial Removal

Homepage Star of August 2013
[ Author:Fushun Ma | Time:2013-09-25 09:14:30 |  Font Size: [Large Medium Small]
Tags: masseter muscle removal, mandible reduction, facial reshape

For those whose mandible bone is not big and the mandible angles are not eversion, a simple partial masseter muscle removal could well redefine the Square Face to a Oval one. Except candidates with remarkable eversion mandible angles the facial width of all other square faced candidates could be reduced by masseter muscle resection. On the contrary without muscle reduction a pure mandible bone reduction can not do much in reducing the facial width in Square Face reshaping surgery. That is the reason why many facial reduction surgery candidates still found their face in a square shape after their mandible reduction surgeries. Therefore Dr. Fushun Ma routinely resects the masseter muscle during the procedure of mandible reduction surgeries in the past 10 years. The amount of muscle removal is tailored according to the individual need.

The boy in this page not only did masseter muscle partial removal but also buccal fat resection. It is easy to resect the buccal fat during the procedure of masseter muscle reduction within the same surgical incision. However not all the candidates of masseter muscle reduction surgery need buccal fat removal. Indications for simultaneous buccal fat removal include localized facial bulginess at the font edge of the masseter muscle and localized augmentation at the front part of the cheek during suction movement of the mouth. If a regular sized buccal fat which does not cause localized bulginess is resected facial indentations may follow the surgery. And this kind of indentations make people look older. So a careful eva luation should be commenced before the surgery in order to avoid unwanted adverse finial result.

masseter muscle and buccal fat removal
After masseter muscle and buccal fat partial removal the sharp angle below the earlobe disappeared and the facial outline turned smoother.

masseter muscle partial resection
The localized bulginess in the cheek disappeared after the masseter muscle and buccal fat reduction.

chin up position after masseter muscle and buccal fat removal 
Before and after surgery photos in chin up position show the facial width reduction and facial outline change.

In the front view photo the boy's chin was not wide before surgery, however if we trace the chin line back toward the angle of the mandible we could find out the width of the mandible seems getting bigger abruptly. This makes the facial outline angle below the earlobe sharp and the facial outline in a square type. The attachment point of the masseter muscle is where the mandible starts to become wider. The overgrowth of the masseter muscle made this boy's face square however the CT scan showed that his mandible bone was not big and his mandible angle was not eversion, In this scenario masseter muscle reduction is the perfect choice of need for this boy's facial reshaping. The after surgery photo demonstrated the positive facial reduction effect of this surgery. The width of his mandible is reduced and the angles below the earlobe disappeared. His facial type changed to a "Oval Type".

In the angled view photo the middle part of the lower cheek is augmented pre operatively as shown by the arrow. This is because of the masseter muscle and buccal fat overgrowth. The partial removal of the masseter muscle and the buccal fat made this part of the cheek flat and the whole face looks smoother in the post surgery photo.

In chin up position the mandible line starts to augment at the attachment of the masseter muscle as shown by the red arrow. And a relative indentation is formed in front of the masseter muscle attachment as shown by the white arrow. The muscle augmentation made that part of the mandible thicker thus that part of the face is wider. As more muscle was been removed near the mandible angle the post operation changes is more obvious near the mandible angle. In the post surgery photo both the augmentation and indentation caused by the masseter muscle are disappeared.

 the removed muscle and fat tissue
The removed tissue from the masseter muscle includes muscle and tendon, the amount of removal on the left side is slightly bigger. The removed tissue from the buccal is purely fat tissue.

The photo above shows the removed muscle and buccul fat tissue. The removed tissue from the buccal is almost pure fat and the amount from both side is equivalent. while the removed masseter muscle includes muscle and tendon tissue and the amount from the left side is bigger than right side because the left side of the masseter muscle was bigger. This differentiated resectomy was designed to balance the size of both side of the mandible.

During the procedure of masseter muscle removal only part of the masseter is been resected, so the procedure is called the Partial Masster Muscle Resectomy. After the partial removal the functional interference of the masseter muscle is miner and short last. The functional recovery of the remaining muscle and the compensatory functional enhancement of the other chewing muscles will generally restore the chewing force to the pre surgery level. Even if there is some sort of functional loss in a small number of patients who underwent partial masseter muscle resectomy, the remaining chewing function will still be well competent to accomplish normal eating. It is unnecessary to worry about the chewing functional loss after partial masseter muscle removal.

The muscle re-growth after partial masseter muscle resectomy is different from the Botox injection. The muscle atrophy caused by the use of Botox injection generally recovered in several months after the injection and the facial reduction effect disappears in the same time as well. Though after a repeated injection some of the patients will received a permanent facial reduction effect, however this kind of permanent effect is not constantly repeatable for all the patients because the mechanism of this kind of permanent atrophy is still not clear. In contrary after partial muscle resectomy big amount of muscle fibers and muscle cells are been removed. As we know the umber of the muscle cells are quite fixed in adult the only way for the muscle to regain the original size is through volume increase of individual muscle cells and this volume increase is limited. So it is impossible for the size of the masseter muscle to go back to the original, thus the facial reduction effect is permanent.

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