Facial Retaining Ligaments: Why Releasing Them Is the Core of a Deep Plane Facelift

6 hours ago

5 min read

Quick answer: Facial retaining ligaments are strong fibrous bands that run from the bone and deep tissues to the skin and hold the soft tissues of the face in place. The most important for facelift surgery are the zygomatic ligaments over the cheekbone, the masseteric ligaments along the jaw muscle, the mandibular ligament near the chin and the cervical retaining ligaments in the upper neck. With age, the tissue between these anchors sags. In a deep plane facelift these ligaments are released so the cheek, jowl and neck can be lifted freely and fixed higher, with little tension on the skin.

Key takeaways

Retaining ligaments act like anchors between bone and skin.
Sagging tissue hangs between and below these anchors, creating jowls and folds.
Lifting skin without releasing the ligaments pulls against them and can look stretched.
Releasing them lets the deeper layer move as a single unit.
The facial nerve branches run near some ligaments, so anatomy knowledge is essential.

The main retaining ligaments

Zygomatic ligaments: over the cheekbone; they hold the cheek fat. Releasing them allows the midface to lift.
Masseteric ligaments: along the front of the chewing muscle; the jowl forms just in front of them.
Mandibular ligament: near the jawline in front of the jowl; it contributes to the groove in front of the jowl (the marionette area).
Cervical retaining ligaments: in the upper neck, near the angle of the jaw; they affect how far the neck can be lifted.

How ligaments create the signs of ageing

The ligaments themselves stay relatively fixed, while the tissue between them loosens and descends. The result is a face with fixed points and hanging areas in between: the jowl below the masseteric ligaments, the heavy fold beside the nose below the zygomatic ligaments and a softer neck below the jaw.

Video: Scarless facelift on the operating table: one side lifted, one side not yet performed. Watch on YouTube

The short video above shows the same patient on the operating table with one side of the face already lifted and the other side not yet treated. Comparing the two halves at the same moment shows how much the cheek, jowl and jawline move once the tissue is released and repositioned.

Facelift before and after
Scarless facelift before and after
Scarless facelift before and after

Why release matters

When only the skin is lifted, the skin carries the pull, which can create a flat, stretched look and wider scars. SMAS tightening without release has less effect towards the centre of the face, because the ligaments still hold the deep tissue down. When the ligaments are released, the deep layer can be moved where it is needed and fixed there. The skin follows without tension.

"A ligament is not the enemy. It is a landmark. Releasing the right ones, in the right order, is what lets a face move back without looking pulled." — Prof. Dr. Suleyman Tas

Is releasing ligaments safe?

The branches of the facial nerve that move the muscles of expression run close to some of the ligaments, especially near the zygomatic and masseteric areas. A surgeon trained in deep plane anatomy knows where these branches lie and dissects in a plane that protects them. Temporary weakness of a branch can occur after any facelift and usually recovers over weeks to months; permanent injury is rare. Read deep plane facelift risks and complications.

Video: Scarless facelift and neck lift: lift test on the operating table, before and after. Watch on YouTube

The second video, viewed nearly 1 million times, shows a lift test on the operating table: before surgery, a gloved hand gathers the cheek and neck skin to show how much tissue can be repositioned, followed by the result right after the operation.

Ligaments and the neck

The neck is lifted in continuity with the jawline when the cervical retaining ligaments are released. Combined with tightening of the platysma muscle, this gives a sharper angle between the jaw and the neck. See deep plane neck lift and jawline definition.

What this means for you as a patient

When you compare facelift offers, ask the surgeon which ligaments will be released and why. A clear, anatomical answer is a better sign than a brand name for the technique. You can also read how to choose a deep plane facelift surgeon.

Recovery after ligament release

Releasing ligaments does not make recovery much longer for most patients. Swelling in the cheeks and along the jaw is common in the first 2 weeks, and the face can feel tight or numb for a few weeks. The final contour appears over 3 to 6 months.

A short history of the idea

Surgeons described the facial retaining ligaments in the late 1980s and 1990s, and this anatomy changed facelift surgery. Before then, most facelifts lifted the skin alone or tightened the SMAS from above. Once it became clear that the ligaments hold the sagging tissue in place, techniques that release them, including the deep plane facelift and the composite facelift, were developed and improved over the following decades.

Ligaments and fillers

Fillers placed near the ligaments can temporarily support sagging areas, which is why cheek and jawline fillers can help early on. They do not move the tissue back, however, and large amounts can add weight. When surgery is planned, it helps to tell the surgeon where and when fillers were placed. See facelift vs fillers.

Frequently Asked Questions

What are retaining ligaments in the face?

They are strong fibrous bands that connect the deep tissues and bone to the skin and hold the soft tissues of the face in position.

Why are ligaments released in a deep plane facelift?

Because they hold the sagging tissue down. Once released, the cheek, jowl and neck can be lifted as one unit with little tension on the skin.

Does releasing ligaments cause the face to sag again faster?

There is no good evidence that it does. The tissue is fixed in the deep layer and heals in its new position.

Is ligament release risky for the facial nerve?

Some nerve branches run near the ligaments, so the dissection requires anatomical training. Temporary weakness can occur; permanent injury is rare.

Do all facelifts release ligaments?

No. Skin-only lifts and many SMAS plication facelifts do not. Deep plane facelifts do.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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