Instrumental Analysis of Retaining Ligaments and Literature Review. What Can We Deduce?

Objective: This article aimed to review systematically the literature to better characterize retaining ligaments of the face and their changes correlated to facial aging. The authors have investigated the retaining ligament dimensions in 2 different cohorts of patients. Background: Osteocutaneous facial retaining ligaments play an important role in the aging face. With the advancement of techniques and technologies used in procedures of facial rejuvenation, several structures of the face must be highlighted to obtain clinical success as the facial retaining ligaments. It is known that classic characteristics of the aged face imply in the retaining ligaments, the intimate relationship of the ligaments with the cutaneous tissue can be modified by structural and functional changes. Methods: Sixty patients, divided into 2 different cohorts age correlated, have undergone soft tissue ultrasound echography to measure the dimensions (length and thickness) of 2 retaining ligaments (zygomatic cutaneous ligament and mandibular ligament). Results: No significant differences in age correlation have been found in the dimensions of the 2 major retaining ligaments of the face. Conclusion: Retaining ligaments do not undergo substantial time-correlated changes to absolve their retentive function, unlike other facial layers (bone and fat compartments). This observation suggests that retaining ligaments must be preserved during sub–superficial musculoaponeurotic system dissection in a facelift procedure.