Facial retaining ligaments based on real color sectioned images with 3D models: Toward a more precise classification

Facial retaining ligaments play a crucial role in maintaining and supporting skin with the superficial musculoaponeurotic system. However, visualizing these ligaments in detail has been challenging due to the limitations of cadaver dissection and radiologic images for plastic surgery. This study aims to visualize and refine the anatomical definitions of the facial retaining ligaments using high-resolution, true-color sectioned images and three-dimensional models. Facial retaining ligaments with their neighboring structures were identified in the sectioned images and reconstructed into 3D models. Using these sectioned images and 3D models, the ligaments were anatomically analyzed alongside neighboring structures. The study revealed distinct morphological features of the retaining ligaments (orbital retaining ligament with the lateral orbital thickening, zygomatic ligament, maxillary ligament, platysma-auricular ligament, masseteric ligament, mental ligament, medial mandibular ligament, mandibular osteocutaneous ligament, cervicomental angle suspensory ligament), including their orientation relative to the skin and their role in anchoring SMAS and adjacent tissues on the real color datasets. These findings enhance our understanding of facial anatomy and offer valuable insights for surgical planning and safer aesthetic procedures. This approach demonstrates the potential of high-resolution anatomical imaging as a superior alternative to traditional dissection and grayscale radiologic imaging.