Anatomy of the Facial Glideplanes, Deep Plane Spaces, and Ligaments: Implications for Surgical and Nonsurgical Lifting Procedures.

Abstract

The soft-tissue glideplanes of the face are functionally important and have a role in facial rejuvenation surgery. The aim of this study was to improve understanding of soft-tissue mobility of the face and its effect on the redraping of tissues involved in face lifting. The consequences of no-release and extensive-release lifting were analyzed to explain the difference in efficacy and potential longevity between these 2 contrasting philosophies. Preliminary dissections and macrosectioning were followed by a definitive series of standardized layered dissections on 50 cadaver heads, along with histologic analysis, sheet plastination, and mechanical testing. The previously described spaces are potential surgical dissection planes deep to the superficial fascia layer. The classically described retaining ligaments are local reinforcements of a system of small retaining fibers (retinacula cutis and deep retinacula fibers) that provide support to the soft tissues of the face and neck against gravitational sagging while allowing certain mobility. This mobility is used when mobile tissues are lifted without surgical release. However, the process of dragging up these fibers results in a loss of their previous antigravitational, supportive orientation. No-release lifting techniques, such as thread lifts and minimal-invasive face lifts, tighten tissue laxity with a change of the gravity-opposing tissue architecture, placing the weight of the flap solely on the fixation, which limits longevity of the lift. The alternative-full release with redraping-enables reattachment of the flap to a higher position, with preservation of the original deep fascial architecture with its antigravity orientation and natural mobility, conceivably improving the longevity of the lift.