Facial retaining ligaments are crucial anatomical structures for support and definition of facial contours. This article explores detailed anatomy of these ligaments, their importance in maintaining facial structure, and surgical techniques used for their release, emphasizing Dr. Robério Brandão’s Modern Face philosophy.
Understanding function and precise location of these ligaments is fundamental for surgeons seeking natural and long-lasting facial rejuvenation results. Controlled surgical release of these ligaments, when performed with deep anatomical knowledge and refined technique, allows mobilization and repositioning of facial tissues, restoring harmony and youthfulness to the face.
What Are Facial Retaining Ligaments?
Facial retaining ligaments are fibrous structures connecting skin and subcutaneous tissues to deep structures, such as periosteum (membrane covering bones) and fascia. They act as fixation points, supporting face and resisting gravity.
Function of Retaining Ligaments
The main function of retaining ligaments is to maintain structural integrity of face, supporting skin and soft tissues and defining characteristic facial contours. They play crucial role in youthful appearance of face, preventing ptosis (sagging) of tissues.
With aging, these ligaments can lose elasticity and strength, resulting in skin sagging, wrinkle formation, and loss of definition of facial contours.
Types of Retaining Ligaments
Facial retaining ligaments are classified into two main types:
- True ligaments: Connect skin directly to bone.
- False ligaments: Connect skin to fascia or other fibrous structures.
Detailed Anatomy of Facial Retaining Ligaments
Understanding precise anatomy of retaining ligaments is essential for any facial rejuvenation procedure. Below, we detail main ligaments and their locations:
Zygomatic Ligaments
- Location: Originate in zygomatic bone and insert into skin of malar region (cheeks).
- Function: Support projection and volume of cheeks, defining malar contour.
- Importance: Controlled release of these ligaments allows elevation and repositioning of cheeks, restoring youthfulness of midface.
Orbito-Malar Ligament
- Location: Extends from inferior orbital rim to skin of malar and lower eyelid region.
- Function: Supports transition between lower eyelid and cheek, smoothing junction between these areas.
- Importance: Its release contributes to improvement of nasojugal groove (tear troughs) and rejuvenation of periorbital region.
Masseteric Ligaments
- Location: Extend from masseter muscle to skin of lateral mandibular region.
- Function: Support skin of mandibular region, preventing formation of jowls.
- Importance: Their release allows improvement of mandibular contour and reduction of jowls.
Mandibular Ligaments
- Location: Originate in mandible bone and insert into skin of chin and submental region (below chin).
- Function: Support skin of chin and neck, defining mandibular contour and preventing double chin formation.
- Importance: Their release contributes to improvement of mandibular contour and reduction of double chin.
Temporal Ligaments
- Location: Extend from temporal fascia to skin of temporal region and eyebrow.
- Function: Support skin of temporal region and tail of eyebrow, preventing eyebrow ptosis and formation of wrinkles in temporal region.
- Importance: Their release allows eyebrow elevation and rejuvenation of temporal region.
Surgical Release Techniques of Facial Retaining Ligaments
Surgical release of retaining ligaments is fundamental part of many facial rejuvenation procedures, such as facelift (rhytidectomy) and midface lift.
Surgical Approaches
There are different surgical approaches for releasing retaining ligaments, including:
- Open approach: Involves larger incisions and direct tissue dissection.
- Endoscopic approach: Uses smaller incisions and endoscope (camera) to visualize and release ligaments.
- Minimally invasive approach: Combines smaller incisions with precise dissection and release techniques.
Release Techniques
Release techniques may vary depending on type of ligament and surgical approach used. Some common techniques include:
- Dissection: Use of surgical instruments to separate ligaments from adjacent tissues.
- Section: Cutting ligaments with scissors or scalpel.
- Cauterization: Use of electric energy to cut and coagulate ligaments.
Care and Considerations
Release of facial retaining ligaments must be performed with extreme precision and care to prevent damage to adjacent structures, such as nerves and blood vessels. Deep knowledge of facial anatomy is essential to ensure safety and effectiveness of procedure.
Modern Face Philosophy and Release of Retaining Ligaments
Dr. Robério Brandão, creator of Modern Face philosophy, emphasizes importance of individualized and minimally invasive approach in releasing retaining ligaments.
“In Modern Face, we seek precise release of retaining ligaments, with minimum trauma and maximum respect for anatomical structures. The goal is to restore harmony and youthfulness of face naturally and lastingly.” — Dr. Robério Brandão
Modern Face Principles in Ligament Release
- Individualization: Each patient is unique, and surgical approach must be adapted to their specific needs and anatomical characteristics.
- Minimally invasive: Prioritization of techniques minimizing tissue trauma and recovery time.
- Preservation: Focus on finding important anatomical structures, such as nerves and blood vessels.
- Harmony: Search for results restoring harmony and youthfulness of face naturally.
Endomidface by Direct Vision Technique
Endomidface by Direct Vision technique, developed by Dr. Robério Brandão, represents innovative approach for releasing retaining ligaments of midface. This minimally invasive technique uses small incisions and delicate instruments to release ligaments with precision, preserving adjacent structures and optimizing results.
Advantages of Modern Approach
- Natural results: Precise and controlled release of ligaments allows more natural and harmonious repositioning of facial tissues.
- Faster recovery: Minimally invasive techniques result in less tissue trauma and shorter recovery time.
- Lower risk of complications: Deep anatomical knowledge and Dr. Robério Brandão’s refined surgical technique minimize risk of damage to nerves and blood vessels.
Relevant Anatomy for This Procedure
Anatomical knowledge is fundamental to understand how results are achieved safely and effectively.
Key Structures
The face is composed of layers that must be understood together:
- Skin: most superficial layer, reflecting aging through wrinkles and sagging
- Subcutaneous tissue: contains fat that redistributes with age
- SMAS (Superficial Musculoaponeurotic System): fundamental layer connecting muscles to skin
- Facial muscles: responsible for expression and dynamic support
- Retaining ligaments: anchor skin to facial skeleton
- Facial nerves: control movement and sensitivity
Surgical Planes
In Modern Face philosophy, we work in specific planes:
- Superficial plane: above SMAS, used in less invasive procedures
- Deep plane (sub-SMAS): below SMAS, allows longer-lasting results
- Subcutaneous plane: used for fat grafting and fat treatment
Why This Matters
Understanding anatomy explains:
- Why certain procedures last longer than others
- How natural results are achieved
- Why surgeon experience is crucial
- How complications can be avoided
“Respect for anatomy is what separates natural result from artificial result. In Modern Face, each structure has its role and must be preserved or repositioned with precision.” — Dr. Robério Brandão
Results and Statistics
Objective data help establish realistic expectations about procedure.
Result Longevity
Longevity of results depends on multiple factors:
| Factor | Impact on Durability |
|---|---|
| Technique used | High — deep plane lasts longer |
| Skin quality | Moderate — firmer skin holds better |
| Sun exposure | High — sun accelerates aging |
| Smoking | High — smoking significantly harms |
| Stable weight | Moderate — fluctuations affect result |
| Genetics | Moderate — individual predisposition |
Modern Face Clinical Series Data
- More than 1,000 facial surgeries without any irreversible motor nerve injury
- Average recovery time: 10-14 days
- Return to work: 7-10 days (average)
What to Expect Realistically
- Immediate: visible improvement, however with edema
- 30 days: result in development
- 90 days: result almost definitive
- 6 months: final result stabilized
“Numbers are important, but each face is unique. Statistics guide expectations, but individual planning determines result.” — Dr. Robério Brandão
Comparison: Techniques and Approaches
Understanding differences between available techniques helps in informed decision making.
Overview of Approaches
| Aspect | Traditional Techniques | Modern Face |
|---|---|---|
| Surgical plane | Generally superficial | Deep (sub-SMAS) |
| Pull vector | Predominantly lateral | Vertical anatomically correct |
| Incisions | Extensive, multiple areas | Minimal, strategically positioned |
| Recovery | 2-4 weeks | 7-14 days on average |
| Durability | 5-7 years | 10-15 years |
| Naturalness | Risk of “stretched” look | Preserves natural expression |
Advantages of Modern Approach
Modern Face technique offers specific benefits:
- More natural results: vertical vector respects facial anatomy
- Shorter recovery time: minimally invasive techniques accelerate healing
- Superior durability: work on deep plane offers longer-lasting support
- Less visible scars: strategic and smaller incisions
- Preservation of expressiveness: face remains natural and mobile
When Each Technique is Indicated
Choice of technique depends on individual factors:
- Degree of aging: more advanced cases may require more complete approaches
- Areas of concern: midface, lower face, or neck have specific techniques
- Patient expectations: balance between desired result and acceptable recovery
- History of previous procedures: revisions require special planning
Detailed Post-Operative Care
Procedure success depends as much on surgical technique as on post-operative care.
First Days: Critical Phase
In this phase, small cares make big difference:
- Elevated rest: keep head elevated at 30-45° even when sleeping
- Cold compresses: apply in first 48h to reduce edema
- Rigorous medication: follow exactly prescribed schedules
- Light diet: prefer soft foods and avoid excessive chewing
- Abundant hydration: water helps in tissue recovery
First Week: Intermediate Care
As healing advances:
- Careful hygiene: clean area as directed, without rubbing
- Avoid sun exposure: use hat and sunscreen when necessary to go out
- Gentle facial movements: avoid exaggerated expressions
- Adequate sleep: body recovers mainly during sleep
- Avoid alcohol and tobacco: both harm healing
Weeks 2-4: Gradual Return
Return to activities should be progressive:
- Light activities: short walks are allowed
- Remote work: can be resumed as per comfort
- Light makeup: generally allowed after 2 weeks
- Moderate exercises: only with medical clearance
- Lymphatic drainage: indicated to accelerate recovery
What to Avoid
During entire recovery period:
- Direct sun exposure on operated areas
- Intense physical activities before clearance
- Alcohol consumption in first 2 weeks
- Smoking (ideally stop 4 weeks before and after)
- Non-prescribed anti-inflammatories
- Sudden movements with face
Conclusion
Facial retaining ligaments play fundamental role in support and definition of facial contours. Controlled surgical release of these ligaments, when performed with deep anatomical knowledge and refined technique, can result in natural and long-lasting facial rejuvenation.
Dr. Robério Brandão’s Modern Face philosophy offers individualized and minimally invasive approach for releasing retaining ligaments, prioritizing safety, harmony, and patient satisfaction.
Frequently Asked Questions (FAQ)
What is the difference between retaining ligaments and fixation ligaments?
Retaining ligaments support skin and soft tissues, while fixation ligaments connect muscles to fascia or bone.
Is ligament release always necessary in a facelift?
Need for ligament release depends on individual characteristics of patient and treatment goals.
What are the risks of excessive ligament release?
Excessive release can result in instability of facial tissues and artificial appearance.
How to minimize risk of nerve injury during ligament release?
Deep knowledge of facial anatomy and precise surgical technique are essential to minimize risk of nerve injury.
Is Modern Face suitable for all patients?
Modern Face is most suitable for patients seeking natural and long-lasting rejuvenation, with shorter recovery time.
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⚠️ Disclaimer
This content is educational and represents author’s technical opinion based on documented clinical experience. Surgical decisions must be individualized.
Author: Dr. Robério Brandão, CRM-CE 8596 Last update: January 2026