Facial Retaining Structures are Not True Ligaments: Clinical Application

BACKGROUND: The so-called facial retaining ligaments have long been described in aesthetic anatomy; however, their histologic characteristics and mechanical behavior differ from those of true ligaments found in the appendicular skeleton. This study aims to clarify the structural and functional nature of these fibrous retaining structures and discuss their clinical implications for soft-tissue filler and collagen biostimulator treatments. METHODS: Cadaveric dissections were performed to examine the morphology, orientation, and histologic features of fibrous connective tissues in the zygomatic, temporal, and mandibular regions. In addition, microcomputed tomography (micro-CT) was used to visualize the 3-dimensional fibrous network commonly referred to as "facial ligaments." RESULTS: Temporal septal fusion demonstrated a dense "ligament-like" septal condensation that is often labeled as ligament tissue; however, it does not represent a true bone-to-bone ligament as defined in other body regions (Fig. 1). Micro-CT revealed that facial "ligaments" form a spider web-like fibrous network, appearing as a thicker and denser form than typical retinacular cutis; this supports the concept that facial retaining structures are best regarded as specialized fibrous anchoring systems rather than true ligaments (Fig. 2). CONCLUSION: Facial retaining structures are better defined as fibrous anchoring systems rather than true ligaments. Understanding their biomechanical variability allows for more precise filler placement, improved contour restoration, and predictable aesthetic outcomes, particularly in East Asian facial morphology.