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Surgical Anatomy of the Middle Premasseter Space and Its Application in Sub–SMAS Face Lift Surgery

Mendelson, Bryan C. F.R.C.S.E., F.R.A.C.S., F.A.C.S.; Wong, Chin-Ho M.R.C.S.(Ed.), F.A.M.S.(Plast. Surg)

Plastic and Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 57–64
doi: 10.1097/PRS.0b013e3182910b70
Cosmetic: Original Articles

Background: The premasseter space is a recognized, sub–superficial musculoaponeurotic system (SMAS) soft-tissue space overlying the lower masseter immediately anterior to the parotid. The performance, safety, and effectiveness of composite face lifts are enhanced when the space is used. This has drawn attention to the need for better understanding of the premasseter anatomy above the space.

Methods: The anatomy of the upper premasseter region was investigated in 20 fresh cadaver dissections as well as intraoperatively in hundreds of composite face lifts.

Results: A small, transverse, rectangular soft-tissue space overlies the upper masseter and was named the middle premasseter space. The space (transverse width, 25 to 28 mm; vertical width, 10 mm) is separated from the originally described (lower) premasseter space by a double membrane. It is a safe space between the upper and lower buccal trunks of the facial nerve, which are immediately outside the space and separated from it by the respective upper and lower boundary membranes. The parotid duct immediately beneath the floor of the space usually underlies the upper boundary membrane.

Conclusions: The middle premasseter space is significant, as it is the center of the key anatomy immediately cephalad to the lower premasseter space. When used in composite face lifts, the space provides predictable sub-SMAS dissection between the buccal trunks of the facial nerve to the mobile area beyond the anterior border of the masseter where the SMAS overlies the buccal fat pad.

Supplemental Digital Content is available in the text.

Toorak, Victoria, Australia; and Singapore

From the Center for Facial Plastic Surgery and W Aesthetic Plastic Surgery.

Received for publication December 21, 2012; accepted January 14, 2013.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No external funding was received.

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Bryan Mendelson, F.R.C.S.E., F.R.A.C.S., F.A.C.S., The Center for Facial Plastic Surgery, 109 Mathoura Road, Toorak, Victoria 3142, Australia,

©2013American Society of Plastic Surgeons