Facial Retaining Structures are Not True Ligaments: Clinical Application.

Area of Science:

• Aesthetic anatomy
• Facial anatomy
• Biomechanical analysis

Background:

• Facial retaining ligaments are described in aesthetic anatomy but differ histologically and mechanically from skeletal ligaments.
• Their true nature and function in facial aesthetics remain unclear.
• Clinical implications for soft-tissue fillers and biostimulators require clarification.

Purpose of the Study:

• To clarify the structural and functional nature of facial fibrous retaining structures.
• To differentiate them from true ligaments.
• To discuss their clinical relevance for aesthetic treatments.

Main Methods:

• Performed cadaveric dissections of zygomatic, temporal, and mandibular regions.
• Examined morphology, orientation, and histology of fibrous connective tissues.
• Utilized microcomputed tomography (micro-CT) to visualize the 3D fibrous network.

Main Results:

• Temporal septal fusion showed dense "ligament-like" condensation, not a true bone-to-bone ligament.
• Micro-CT revealed facial "ligaments" as a spider web-like fibrous network, denser than retinacular cutis.
• Facial retaining structures are specialized fibrous anchoring systems, not true ligaments.

Conclusions:

• Facial retaining structures are accurately defined as fibrous anchoring systems, distinct from true ligaments.
• Understanding their biomechanical variability enables precise filler placement and contour restoration.
• This knowledge is particularly valuable for predictable aesthetic outcomes in East Asian facial morphology.