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LigaSure-assisted Retaining Ligament Release during Composite Deep Plane Face and Neck Lift: A Three-Sign Structured

Vincent McCarty¹, Sami P Moubayed^2,3

¹. Department of Surgery, McGill University, Montreal, Quebec, Canada.

Plastic and Reconstructive Surgery

|June 29, 2026

Summary

Surgeons can now safely release facial ligaments during deep plane facelifts using a new three-sign method with the LigaSure system. This technique minimizes nerve injury risk and improves rejuvenation results.

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Lateral-PLIF for Lumbar Spinal Arthrodesis: A Detailed Step-By-Step Surgical Technique

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Published on: January 23, 2026

Area of Science:

Plastic Surgery
Facial Anatomy
Surgical Innovation

Background:

Complete release of retaining ligaments is crucial for durable deep plane face and neck lift results.
Facial nerve injury is a risk during ligament release due to the proximity of nerve branches.
Current methods rely on subjective clues or separate neuromonitoring, requiring instrument changes.

Purpose of the Study:

To introduce a novel three-sign sequential identification framework for safe ligament release during deep plane facelifts.
To integrate diagnostic probing and tissue division using a single instrument, the LigaSure vessel sealing system.
To provide a structured, reproducible, and teachable approach for a challenging surgical step.

Main Methods:

A three-sign sequential identification framework was developed: Visual Assessment Test, LigaSure Tweak Test, and Skin Tethering Test.
The LigaSure system was utilized as both a diagnostic probe and the division instrument.
Structures were divided only after all three signs confirmed ligamentous identity.

Main Results:

The described framework synthesizes anatomic clues into a structured approach.
The LigaSure system integration eliminates the need for instrument changes during ligament release.
This method enhances safety and reproducibility in deep plane facelift procedures.

Conclusions:

The three-sign sequential identification framework offers a safe and effective method for ligament release in deep plane facelifts.
Integrating diagnostic and division functions with the LigaSure system streamlines the procedure and reduces operative time.
This structured approach addresses the challenges of nerve preservation and achieves durable rejuvenation outcomes.