Is Retention Ligament Release Necessary During Facelift Surgery? Effects and Precautions

The Core of Facelift Surgery: What is a Retention Ligament?

As interest in facelift surgery grows, you will often come across the term 'retention ligament.' Retention ligaments are structures akin to the 'pillars of a building,' playing the role of firmly anchoring the bone, skin, and muscle layers to prevent facial tissues from sagging downwards. While they play a crucial role in maintaining the shape of the face under normal circumstances, they can actually become an obstacle during a facelift surgery, where sagging tissues caused by aging need to be pulled back up.

Why Retention Ligaments Must Be Released During a Facelift

Many patients ask, "Do the retention ligaments really need to be cut?" To get straight to the point, retention ligament release is often recommended to achieve optimal lifting results.

• Securing Freedom of Tissue Movement: When pulling the sagging skin and the SMAS (Superficial Musculoaponeurotic System) layer upwards, if the retention ligaments are holding on tightly, the lifting force cannot be evenly distributed across the entire face.
• Gradual Improvement Effect: Properly releasing the retention ligaments allows the previously anchored areas to become flexible, enabling a smooth and natural lift.
• Preventing Dimpling: Releasing the ligaments prevents the dimpling effect, where specific areas cave in if the tissues are forcefully pulled without cutting the ligaments.

Changes in the Face After Retention Ligament Release

As aging progresses, the areas where retention ligaments hold the skin stretch relatively less, while the surrounding skin sags, causing the submalar (under the cheekbone) or cheek areas to appear hollow. This is commonly referred to as the 'zygomatic retention ligament' area.

By releasing the ligaments in this area through surgery and repositioning the sagging tissues, the inward pulling force is relieved, and you can expect the uneven facial contours to become much smoother. However, this requires precise dissection by an experienced, board-certified plastic surgeon.

The Correlation Between Retention Ligament Reconstruction and Surgical Scope

Some people wonder if the severed retention ligaments need to be reconnected. Realistically, it is not easy to perfectly reconstruct these microscopic ligament tissues to their pre-surgery state. However, the natural adhesion process that occurs during post-operative recovery acts as a support similar to the original retention ligaments, helping to securely anchor the tissues in place.

Differences Based on the Scope of Surgery

Retention ligament release is not mandatory for all lifting procedures. For mini-facelifts or simple procedures with a smaller dissection scope and minimal incisions, the presence or absence of ligament release may have a relatively minor impact on the results. On the other hand, if you desire a definitive facelift effect, the process of properly managing the retention ligaments alongside a wide area of dissection is crucial.

Considerations for a Successful Facelift

While retention ligament release is an important step that enhances the efficiency of a facelift, it alone does not determine the final outcome. Factors such as the length of the incision, the scope of dissection, and the method of managing the SMAS layer must be comprehensively considered. Since numerous nerves and blood vessels pass through the face, it is safest to establish a surgical plan tailored to you through thorough consultation with a board-certified plastic surgeon who possesses extensive anatomical knowledge.