Can Injected Fat From Under the Masseter Muscle Be Removed?
Q: Dr. Eppley, I had an unfortunate fat graft and if englarged my masseter muscle (among other things). I am looking to reduce the masseter area surgically. I do not think that botox will help as some of the bulk is fat. I was told that it was placed UNDER the masseter. Do you know or can you suggest any local maxillofacial drs that could help me with this? I am worried about nerve damage. I also had too much fat along the lower jaw and it looks like jowling. What are your thoughts on smart lipo type procedures? I had regular liposuction to try to fix this with no positive improvment at all. Thank you for your informative website and any advice you can give me.
A: Given that you had liposuction of the masseter/jowls with no improvement, this would indicate that the fat is not in the subcutaneous space (of which you have already mentioned) and therefore no form of liposuction will work. This means then that the fat is either under the masseter muscle, in the masseter muscle or a combination of both. I would think it would be very difficult to get all the fat under the masseter muscle and some of it is likely in the muscle as well. Thus removal would require an intraoral submasseteric approach to get access to the fat. There is no risk of nerve injury in doing so so that should not be a concern. The only issue, in my mind, is how much fat could be removed from this approach and whether any masseter can or should be taken if there is not much fat visible in subperiosteal/subfascial plane. One way to really know where the fat is is to get a high resolution MRI of the masseter area. That would give a good idea beforehand of the success of such a procedure. The jowling fullness is another issue and, if not improved by liposuction, may have to consider some form of a jowl lift for improvement.
I can not give you any recommendations for any local doctors that may perform such procedures as I would think it would be very uncommon and may even make most uncomfortable.
Dr. Barry Eppley