Why Do Ligaments Matter?
Imagine the face as a tent: the bones are the stakes, the skin is the canvas, and the ligaments are the ropes that hold everything in place. When the ropes loosen, the tent sags — creating bags, grooves, and sagging. The facial retaining ligaments (also called retention ligaments or osteocutaneous fixation points) are fibrous structures that anchor the skin and SMAS to bones and deep fasciae. With aging, they weaken, allowing the characteristic ptosis of facial aging.
“You cannot perform quality facial surgery without deeply understanding the retaining ligaments. They determine where the face falls, where it doesn’t fall, and how to correct it.”
- — Dr. Robério Brandão
The Main Retaining Ligaments
Location: Function: In aging: In surgery: )) }
How Ligaments Explain Aging
Facial aging is not uniform — it follows patterns determined by ligaments:
Nasolabial Fold
The zygomatic ligament fixes malar fat. When it weakens, the fat descends, creating the “fold” over the nasolabial groove, deepening it.
Jowl (Mandibular Sag)
The jowl forms in the “window” between ligaments: anterior to the mandibular ligament, where there’s no support. Ptosed tissues accumulate in this area of least resistance.
Festoons and Malar Mounds
The weakening of orbital ligaments allows fluid and tissue accumulation in the palpebromalar region, creating characteristic “bags”.
Brow Tail Ptosis
The temporal fixation zone weakens, allowing the lateral portion of the brow to fall. Contributes to tired appearance.
Surgical Implications
Knowledge of ligaments guides surgical strategy:
Ligament Release
Allows tissue mobilization for repositioning in a younger position. Essential for lasting results.
- • Endomidface: releases zygomatic
- • Deep Plane: releases masseteric, preserves mandibular
- • Browlift: releases temporal zone
Ligament Preservation
Maintains natural anchor points. Can be strategic in some techniques to maintain contours.
- • Partial mandibular preservation
- • Maintenance of orbital ligaments
- • Anchorage in preserved ligaments
⚠️ Point of Attention
Release of the zygomatic ligament exposes the zygomatic branch of the facial nerve. Detailed anatomical knowledge is essential for safe dissection in this region.
Frequently Asked Questions
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Related Articles
SMAS Anatomy
Learn how SMAS and ligaments interact for facial support.
Fat Compartments
How ligament weakening affects facial fat distribution.
Endomidface Guide
The technique that focuses on midface ligament release and elevation.
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