Why Is the Facial Nerve So Important? The facial nerve (VII cranial nerve) controls all facial expression. An injury can cause partial or total paralysis of one side of the face — one of the most feared complications in facial surgery and one of the main reasons why many surgeons avoid deep plane procedures. However, with adequate anatomical knowledge and appropriate technique, risk can be minimized to very low levels. The [Modern Face philosophy prioritizes Maximum Safety precisely by developing techniques that maintain safe distance from the nerve.
“There is no aesthetic result that justifies nerve injury. Safety is non-negotiable.”
- — Dr. Robério Brandão
Facial Nerve Anatomy
The facial nerve emerges from the stylomastoid foramen, traverses the parotid gland where it divides, and distributes five main branches. A useful mnemonic: “Two Zebras Bit My Cookie” (Temporal, Zygomatic, Buccal, Marginal, Cervical).
📍 Fundamental Principle
The facial nerve runs in the sub-SMAS layer, deep to the fascia but superficial to the periosteum. It is ABOVE the subperiosteal plane — that’s why this plane is safer.
The 5 Branches: Function, Injury and Protection
Branch
Function: If injured: Danger zone: Protection: )) }
Why Is the Subperiosteal Plane Safer? The key to understanding subperiosteal plane safety lies in the layered anatomy:
Layers (Superficial → Deep)
1 Skin
2 Subcutaneous fat
3 SMAS / Temporoparietal fascia
4 FACIAL NERVE (in sub-SMAS layer)
5 Deep fascia / Parotid-masseteric
6 PERIOSTEUM (Endomidface dissection plane)
7 Bone
The Endomidface works in plane 6 (subperiosteal). The nerve is in plane 4. There are two layers of tissue between the dissection plane and the nerve — a significant safety margin.
✅ Advantages of Subperiosteal
- • Facial nerve is ABOVE the dissection plane
- • Avascular plane (less bleeding)
- • Predictable and reproducible dissection
- • Allows direct vision without increased risk
- • Less affected by biostimulators
Frequently Asked Questions
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Related Articles
Complications Prevention
A comprehensive guide on surgical safety and risk management.
SMAS Anatomy
Understanding the layer where the facial nerve resides.
Endomidface Guide
Details on the subperiosteal technique for maximum safety.
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