The Retaining Ligaments of the Face, an overview.
Are ligaments important? I think so. Tricky to understand for most of us so let’s break it down.
Topographically we can visualize the relationship of the ligaments to the skin as the “grooves of aging.” (image 2). The location of the retaining ligaments is where these grooves show. Examples of these grooves being the Tear Trough (tear trough ligament), the Palpebral Malar groove (orbicularis retaining ligament), Nasojugal groove (zygomatic cutaneous ligament), and jowls (pre-jowl sulcus corresponds to the mandibular ligament.) All areas we treat daily in our practice.
-The Ligaments (and the more superficial septa) are implicated as the “dividing lines” of the deep and more superficial fat compartments. Therefore an intimate knowlege of ligament anatomy can guide us to inject into the appropriate fat compartment for optimal results.
In one of his literature reviews, Dr Sebastian Cotofana states that “injection of soft tissue fillers should be performed with precise anatomical understanding of facial fat compartments, as one must target a specific fat compartment in order to achieve the desired effect. Applying the product in the wrong fat compartment might yield an undesirable result.” So if the ligaments are creating the defined fat compartments, we have an opportunity to become very specific with our injection approach by studying their anatomy.
The DEFINITION of a RETAINING LIGAMENT:
Simply stated, a true retaining ligament in the face is one that originates on bone and inserts into the skin.
The concept of understanding retaining ligaments is a bit tricky. We have to first consider the layers of the face to truly grasp the 3 dimensional anchoring and insertion from periosteum to dermis that the ligament travels.
In general, the face is arranged in 5 layers: 1) Skin, 2)subcutaneous fat-also containing the retinacula cutis (terminal branches of fibrous connective tissue from the ligament itself), 3) SMAS, 4) deep fat, 5)periosteum. Now imagine the retaining ligament as a tree (image 1) where the trunk of the tree is the thick fibous base of the ligament and as it ascends through the layers of the face it divides into numerous branches, which insert into the skin. This branching network of fibers is called the retinacular cutis. This system of superficial fibrous tissue has been described to contribute to the formation of septa that divide this layer into the superficial fat compartments of the face. (We often feel these septa when we attempt to “pop” our cannula through that resistance we feel in that sub-q plane.)