What it means for a patient
- In deep face lifts, the lower cheek contains nerves and vessels close to the ligaments that are released.
- A camera view may help the surgeon see these structures before releasing tissue.
- Limits: 5 selected cases, description only, and no evidence yet that the endoscope lowers injury rates.
Why this paper matters
It describes the endoscopic anatomy of two deep spaces of the lower face used in sub-SMAS face lifts. The author presents them as natural cavities suited to endoscopic work, pending validation.
Overview
Dissecting beneath the SMAS in the lower premasseter space and buccal space is difficult because nerves and vessels lie close to the ligaments. The author aimed to document these spaces through an endoscope during live surgery. Five cases with high-quality images were selected from 80 sub-SMAS face lifts and reviewed by description only.
Findings
- 5 cases selected from 80 sub-SMAS face lift dissections, based on image quality and preserved anatomy.
- Dissection used a 4-mm, 30-degree endoscope with photo and video records.
- The lower premasseter space was a rhomboid-shaped cavity bordered by the buccinator, masseteric fascia, parotid gland and buccal space.
- The buccal space was a wedge-shaped cavity containing the buccal fat pad, crossed by the facial vessels and buccal nerve branches.
- High-definition photos distinguished ligament, vessel and nerve structures.
- No objective measurements or checks between observers were done.
- Controlled comparative studies are needed to confirm any lower risk of nerve or vessel injury.
Terms
- Sub-SMAS face lift: a face lift that frees tissue beneath the SMAS layer.
- SMAS: the superficial musculo-aponeurotic system, a fibrous and muscle layer under the facial fat.
- Lower premasseter space: a space over the lower part of the masseter chewing muscle.
- Buccal space: a space in the cheek that holds the buccal fat pad.
- Endoscope: a thin tube with a camera and light.
- Masseteric fascia: the tissue layer covering the masseter muscle.
- Neurovascular bundle: a nerve and blood vessels running together.
- Pilot study: a small early study to test an idea before larger research.