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Gotkin, Robert H.; Alfertshofer, Michael G.; Frank, Konstantin and Cotofana, Sebastian (2021): The retaining ligaments of the face and their importance in facelift surgery. In: Journal für Asthetische Chirurgie, Vol. 15, No. 1: pp. 22-27

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Background The ability to reposition facial soft tissue and achieve full-face rejuvenation in facelift surgery is unparalleled. A precise and thorough understanding of facial anatomy, the biomechanical properties of its components and the anchoring structures of the facial soft tissue are vital to provide safe, efficient and superlative results. Objective This paper aims to summarize the anatomy and importance of the facial retaining ligaments in facelift surgery. Methods This narrative review summarizes, from the authors' experience and research, the anatomy of the facial retaining ligaments and their implications in facelift surgery. Results The retaining ligaments of the face are consistent anatomic structures that are present in predictable locations. They divide the soft tissue of the face into spaces and compartments and their release is critical to achieving adequate soft tissue repositioning for a desired aesthetic outcome in facelift surgery. They also serve as helpful and convenient markers for branches of the facial nerve. Some of the facial ligaments of great importance in facelift surgery are the platysma auricular fascia, the zygomatic cutaneous ligament, the masseteric cutaneous ligament and the mandibular cutaneous ligament. Conclusion This narrative review highlights the retaining ligaments of the face, their involvement in the structural stability of facial soft tissues and their role in facelift surgery. In order to adequately reposition facial soft tissues, proper release of the facial retaining ligaments is necessary. By understanding the anatomy of these retaining ligaments, plastic surgeons can better achieve safe, satisfactory and enduring results.

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