Masseteric ligaments: anatomy of the lower cheek
- Nerve
- Highlighted area
Quick facts
- Definition
- Retaining ligaments arranged in a row along the anterior border of the masseter muscle.
- Extent
- From the zygomatic bone above to near the edge of the mandible below.
- Function
- They anchor the SMAS and skin to the deep layers in the lateral cheek.
- With aging
- The lower attachments tend to loosen, and the cheek tissues descend in front of them.
- Relevance in orofacial harmonization (HOF)
- They help explain the jowl, the broken jawline, and the division between lateral and medial cheek.
The masseteric ligaments are retaining ligaments arranged in a row along the anterior border of the masseter muscle, from the zygomatic bone to near the edge of the mandible. They anchor the SMAS and skin to the deep fasciae in the lateral cheek, separating the mobile area in front from the more fixed area over the masseter. With aging, weakening of the lower attachments contributes to the formation of the jowl.
Where are they and how are they organized?
| Portion | Location | Characteristic |
|---|---|---|
| Upper | Next to the zygomatic bone, continuing the zygomatic ligaments | Stronger attachments |
| Middle | Along the anterior border of the masseter, in the middle of the cheek | Separates lateral and medial cheek |
| Lower | Near the edge of the mandible | Weaker attachments, which loosen first |
Behind this row lies the premasseter space, a gliding space over the lower part of the masseter. In front and below, near the chin, is the mandibular ligament, which anchors the skin to bone. Together, these structures define the fixed and mobile points of the lower cheek.
What changes with aging?
- Lower loosening: the lower attachments lose firmness, and the premasseter space becomes laxer.
- Tissue descent: cheek fat and skin descend in front of and below the ligaments, accumulating over the jawline.
- Broken contour: between the jowl and the fixed point of the mandibular ligament, the pre-jowl sulcus appears and interrupts the jawline.
The assessment of the whole picture is covered in lower third laxity: assessment.
Why does it matter in orofacial harmonization (HOF)?
- Reading the jowl: understanding that the jowl is descended tissue, not a lack of volume in the jaw, changes the indication. In many cases, combining support in other areas with treatment of laxity is discussed before any local volume.
- Jawline: jawline filler works on the bony line; the result depends on how much loose tissue lies above it.
- Nearby structures: the facial vein runs along the anterior border of the masseter, and buccal branches of the facial nerve pass through the region.
How does it show up in the assessment?
- Oblique and profile views: position of the jowl and depth of the pre-jowl sulcus.
- Traction test: gently lifting the cheek skin shows how much of the contour is descended tissue.
- Masseter palpation while clenching the teeth, to locate the anterior border.
Also called: cutaneous masseteric ligaments, masseteric cutaneous ligaments, masseteric retaining ligaments.
Frequently asked questions
What are the masseteric ligaments?
They are fibrous attachments that rise from the fasciae over the front edge of the masseter muscle to the SMAS and skin, forming a row from the zygomatic bone to near the mandible. They are part of the retaining ligaments of the face and support the lateral cheek.
How are the masseteric ligaments related to the jowl?
With age, the lower masseteric ligaments tend to loosen, while the mandibular ligament in front holds the skin near the chin. The cheek tissues descend between the two points and form the bulge along the jawline known as the jowl.