Dr. Justin O’Brien, a Brighton-based ENT surgeon and one of the original MAFAC members, has allowed his thesis on facial anatomy to be shared on the MAFAC website. Although the majority of the findings were published in four papers and one textbook chapter, the unpublished findings form the groundwork for the future research.

The thesis of the Brighton-based ENT surgeon Justin O’Brien, titled “The Relationship of the Facial Nerve Rami to the Tissue Layers, Spaces, and Retaining Ligaments of the Face”, will be available through the MAFAC website in the section Anatomy News. Dr. O’Brien was an original MAFAC member from the time he was a Fellow with Dr. Bryan Mendelson. The PhD was undertaken from 2010 to 2014 under the supervision of prof. Mark Ashton, the Course Chairman of MAFAC. This generosity will encourage more original work of the different MAFAC members to be shared through this channel.

Chapter 1 is an extensive and historically relevant literature review on the anatomy and nomenclature of the facial nerve rami.

Chapter 2 covers the anatomy of soft tissue planes, spaces and retaining ligaments as well as the relationship between the soft tissue structures and visible landmarks as the face ages. It was published as a chapter in the International Textbook of Aesthetic Surgery, co-written with Dr. Bryan Mendelson. 1

Chapter 3 describes the landmarks for locating the facial nerve trunk and was published in the Journal of Plastic, Reconstructive and Aesthetic Surgery. 2

Chapter 4 explains the difference between Lore’s fascia and the platysma-auricular ligament, which are commonly confused and used interchangeably in the literature. Also, the safety of the facial nerve trunk when placing platysma suspension sutures was discussed. The article was published in the Journal of Plastic, Reconstructive and Aesthetic Surgery.3

Chapter 5 describes the relationship of the marginal mandibular nerve branches of the facial nerve to the lower premasseter space. Supported by extraordinary anatomic dissection images, this article provides evidence of marginal mandibular nerve branches exiting the masseteric fascia and perforating the platysma along the course of the mandibular septum. This original but unpublished research provides subject for thought and further research.

Chapter 6 is a literature review and dissection study of the soft tissue layers and retaining ligaments of the temporal region, to clarify both the anatomy as well as the nomenclature which was conflicting in literature, and was published in the Journal of Plastic and Reconstructive Surgery. 4

Chapter 7 is the final chapter and describes the relationship of the facial nerve rami to the soft tissue layers described in chapter six, and was published in the Annals of Plastic Surgery. 5

A Building is only as strong as its Foundation

Lower premasseter space: The forceps is grasping the mandibular septum. The red arrows point at the platysma-innervating branches of the marginal mandibular nerve exiting the masseteric fascia and entering the SMAS plane.


1 Scuderi N, Toth BA (2016) International Textbook of Aesthetic Surgery. Springer, New York, p 1 855 – 865

2 O’Brien JX, Rozen WM, Ting JW, Leung M. A simplified landmark for the facial nerve trunk in parotidectomy: the sternocleidomastoid origin. J Plast Reconstr Aesthet Surg. 2012;65(6):832-833. doi:10.1016/j.bjps.2011.11.041

3 O’Brien JX, Rozen WM, Whitaker IS, Ashton MW. Lore’s fascia and the platysma-auricular ligament are distinct structures. J Plast Reconstr Aesthet Surg. 2012;65(9):e241-e245. doi:10.1016/j.bjps.2012.03.007

4 O’Brien JX, Ashton MW, Rozen WM, Ross R, Mendelson BC. New perspectives on the surgical anatomy and nomenclature of the temporal region: literature review and dissection study. Plast Reconstr Surg. 2013;131(3):510-522. doi:10.1097/PRS.0b013e31827c6ed6

5 O’Brien JX, Ashton MW. Relationship of the temporofrontal rami of the facial nerve to the fascial layers of the temporal region. Ann Plast Surg. 2012;68(6):547-548. doi:10.1097/ SAP.0b013e318221b563

Submit your Question