The retaining ligaments of the face are the single most important anatomical concept in deep plane facelift surgery. They are the reason that deep plane produces different results from SMAS facelift — and understanding them makes clear why releasing them is not optional if you want natural, long-lasting facial rejuvenation.
— Dr. Umut Zereyak
What are retaining ligaments?
Retaining ligaments are dense, fibrous condensations that run from the periosteum of the facial bones — the fibrous layer covering the bone — through the SMAS and the overlying fat compartments, to insert into the dermis of the skin. Their function is to anchor the soft tissue of the face to the underlying bony skeleton, maintaining facial contour and supporting the fat compartments in their anatomical positions.
With age, these ligaments elongate and weaken. The fat compartments they support descend, creating the nasolabial folds, jowls, and neck changes characteristic of facial aging. The ligaments do not fail completely — they remain intact enough to tether the SMAS to the bone — which is precisely the problem for surgeons attempting to reposition the SMAS without releasing them first.
The four key retaining ligaments
Zygomatic ligament
Originates from the body of the zygoma (cheekbone) — runs through the malar fat pad to insert into the overlying skin.
The most important ligament for mid-face rejuvenation. Tethers the malar fat pad to the cheekbone. Releasing it allows the entire cheek complex to be repositioned superiorly — directly improving the nasolabial fold and restoring malar projection.
Also referred to as McGregor's patch in the surgical literature. Located at the anterior border of the masseter muscle at the level of the zygoma.
Masseteric ligament
Series of ligamentous attachments along the anterior surface of the masseter muscle — extending from the zygomatic arch to the mandibular border.
Tethers the SMAS and overlying tissue to the parotid-masseteric fascia. Release allows the lower facial composite to move freely. Critical for jowl correction and mandibular border definition.
The masseteric ligaments are encountered during deep plane dissection as it proceeds inferiorly from the zygomatic release.
Mandibular ligament
Originates from the anterior mandible at the mandibular border — inserts into the overlying skin.
Primary anchor for the jowl region. Releasing the mandibular ligament allows the jowl tissue to be repositioned, restoring a clean mandibular border and reducing lower facial heaviness.
One of the two "true" osteocutaneous ligaments of the face (along with the zygomatic ligament) — running directly from bone to skin.
Orbicularis retaining ligament
Runs along the inferior orbital rim — connects the orbicularis oculi muscle to the underlying orbital periosteum.
Relevant in composite facelift and extended deep plane techniques. Release addresses the lower eyelid-cheek junction and tear trough deformity. Not released in standard deep plane facelift — addressed when the composite technique is indicated.
Also called the orbital retaining ligament or orbitomalar ligament in some nomenclature systems.
What happens when ligaments are released
When the zygomatic and masseteric ligaments are released during deep plane surgery, the tissue composite — skin, subcutaneous fat, and SMAS — moves freely as a single unit. There is no internal resistance from tethering structures. The composite can be elevated vertically and repositioned to the patient's youthful anatomy without placing tension on the skin surface.
This is the fundamental mechanical difference between deep plane and SMAS facelift. In a SMAS facelift, the SMAS is being pulled against the resistance of intact ligaments. To achieve visible improvement, force must be applied — which distributes to the skin, creating tension that produces the characteristic operated appearance over time.
In deep plane surgery, the ligaments are released before the tissue is moved. The composite then moves to its new position without resistance, and without skin tension. The incision closure is under minimal tension — which produces finer scars, more natural tissue movement, and a face that looks like itself at a younger age.
Technical considerations in ligament release
Releasing the retaining ligaments is not a single incision. It requires dissection under direct vision in a plane below the SMAS, with careful identification of each ligament and its relationship to the facial nerve branches that course near them.
The facial nerve branches most relevant to this dissection are the zygomatic branches (which can course near the zygomatic ligament release) and the marginal mandibular branch (relevant to the mandibular ligament region). Precise anatomical knowledge and careful dissection technique are essential — which is why deep plane facelift is performed by a smaller proportion of surgeons than SMAS techniques.
In my practice, I identify each ligament under direct vision and release it under loupe magnification. The facial nerve branches in this region have consistent anatomical locations, and protecting them while releasing the ligaments is technically demanding but reliably achievable with appropriate experience and technique.
Composite facelift: adding the orbicularis
In some patients — particularly those with significant lower eyelid laxity or a deep tear trough — the standard deep plane dissection is extended to include release of the orbicularis retaining ligament. This variant, called the composite facelift, incorporates the lower orbicularis oculi into the tissue composite, allowing the tear trough and lower eyelid-cheek junction to be directly addressed.
The composite technique adds technical complexity and requires a surgeon familiar with both the orbital anatomy and the deep plane approach. It is not appropriate for all patients — I assess whether it is indicated based on the individual anatomy at consultation.
Read: Composite facelift vs deep plane — which is appropriate? →
References
- Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. 1989;83(1):11-16. doi:10.1097/00006534-198901000-00003
- Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg. 1990;86(1):53-61. doi:10.1097/00006534-199007000-00010
- Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. 1992;89(3):441-449. doi:10.1097/00006534-199203000-00007
- Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg. 2002;110(3):885-896. doi:10.1097/00006534-200209010-00022
- Jacono AA, Malone MH, Lavin TJ. Clinically relevant anatomic findings in deep-plane facelift. Plast Reconstr Surg. 2020;145(6):1359-1368. doi:10.1097/PRS.0000000000006838
Further reading
- SMAS anatomy: the foundation of facelift surgery →
- Composite facelift vs deep plane: when orbicularis matters →
- Deep plane vs SMAS: full comparison →
- Deep plane facelift for men: technical differences →
Discuss your anatomy with Dr. Zereyak
The retaining ligament anatomy of every face is slightly different. A free video consultation with Dr. Zereyak allows him to assess your specific anatomy and explain which approach is most appropriate.