Anatomic study of the retaining ligaments of the face and applications for facial rejuvenation

Background: The retaining ligaments of the face support the facial soft tissue in a normal anatomic position, thereby resisting gravitational change. In this study, a technique utilizing surgical plication of the superficial musculoaponeurotic system (SMAS) to the retaining ligaments of the face and finger-assisted malar elevation (FAME) dissection of the midface is presented. Methods: The anatomy of the facial retaining ligaments was studied in 20 half-faces of ten fresh cadavers, and the localization of the ligaments was examined macroscopically. Surgical correction of facial aging with plication of the SMAS to the retaining ligaments and FAME dissection of the midface has been performed in 74 face-lift patients since 2006. Outcomes were determined by case notes, clinical review, and a patient questionnaire. Results: The studied ligaments (zygomatic and masseteric) were present in all cadaver dissections. The zygomatic ligament was located 4.3-5.5 cm from the tragus and originates near the inferior border of the anterior zygomatic arch. The masseteric ligament was located 3.7-5.2 cm from the tragus below the junction of the zygomatic arch and masseter muscle. All the patients answered a satisfaction questionnaire and reported high levels of satisfaction at least 1 year after treatment. Conclusions: We have identified the facial retaining ligaments in all cadaver dissections and their relationship with other structures of the face are described here. This study demonstrates that our face-lift technique is safe and produces highly predictable and natural results. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.