Would Removing the SMAS Create A Facial Thinning Effect?

Q: Dr. Eppley, I am interested in facial thinning. I have a soft tissue region around the jaw area (just below the TMJ), it is a narrow strip that runs along the back border of my jaw as it goes from the angle to the TMJ. This region flares out and gives the appearance of an overly wide face. I have been to some parotid specialists and they have confirmed that I have no parotid swelling and that it is other tissue – SMAS/fatty tissue. I am about 10% body fat, so it is not because I am overweight. I was wondering if you could reduce this region of the face by removing this tissue?

A: The area on the face to which you refer is composed of the parotid gland and the SMAS layer. Undoubtably the greater fullness in this area is whatever size the parotid gland is. The SMAS layer is not that thick particularly at only 10% body fat. Can the SMAS layer be thinned out/removed in this area? Yes although there are branches of the buccal facial nerve that are at some risk of injury and removing the SMAS over the parotid gland creates the risk of a parotid sialocoele or salivary leak. All of these risks associated with lateral side of the facial thinning are done without knowing whether it would make much of a difference. The best way to answer that question is to get an axial MRI of the face where that question can be answered.

Dr. Barry Eppley

Indianapolis, Indiana