Masseter Muscle Detachment

Q: Dr. Eppley, I am happy with results of my custom jawline implant and am now ready to tackle the masseter muscle detachment issue. It appears to me that there are three options available:

1) Muscle reattachment surgery,

2) AlloDerm or similar regenerative tissue matrix,

3) Permanent/ semi-permanent filler ( Bellafill). Each option obviously comes with its own set of pros and cons. Which approach would you recommend?

A: The one option you have left off the list, which would be under #3, is fat injections. I would not use so called permanent filler.

You are correct, each has their own advantages and disadvantages which are as follows:

1) While trying to relocate the masseter muscle is the most biologic of the treatment options, it has a low rate of success and requires the placement of neck incisions to do so.

2) Placing a layer of Alloderm (cadaveric dermis) over the missing muscle area will increase soft tissue thickeness of the implant and requires only a very small incision right at the angle to do so. Alloderm has proven to be non-resorbable.

3) Fat injections requires no incision to place and provide unlimited volume for coverage if one has enough fat to harvest somewhere. Its issues is its unpredictability of survival. This is often the first option to pursue because there is no risk of any aesthetic tradeoff.

Dr. Barry Eppley

Indianapolis, Indiana