What does releasing of ligaments mean in a facelift? How many would be released and where on the face, how are they reattached?

Retaining ligaments anchor the dermis, subcutaneous fat and SMAS to the bony periosteum or deep fascia. The role of these ligaments to support facial soft tissues against forces of gravity. The attenuation of retaining ligaments with aging leads downward displacement of soft tissues, and responsible for many of the stigmata that occur with aging. Inadequate release of these retaining ligamentous attachments during facelift prevent the transmission of traction toward mid face which may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. Additional attempts to improve untreated nasolabial folds such as fat grafting to malar region are more likely to result with a “stuffed look”, “operated appearance”. Extended techniques such as deep and composite plane facelifts involving the surgical release of mid facial ligaments produce combined, balanced, and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure.

The Lift and Fill Face lift which combines the modern anatomic concepts of facial aging and the role of central facial  fat compartments with deep layer SMAS lifting to allow for natural long term results in facial rejuvenation today .    The use of Fat in facial rejuvenation with a modern Lift and Fill Face Lift has not only changed the results but also refocused our surgical techniques .   The key to natural results is to analyze each patient's aging face and stylize the face lift technique to allow for the best results for that person.   Please find a board certified Plastic surgeon with the expertise and experience in facial rejuvenation and also who understands the science of aging 

This is a technical question regarding the nuances of the different approaches to facelift surgery and how the deeper tissues are repositioned to improve the results from facelift surgery. There a couple of ligaments which when released allow a more effective lift and redraping of the skin.However, these retaining do not need to be reattached. The tension of the SMAS lift will provide the rejuvenating effect  Depending on what the ageing problems are in the first instance your surgeon can advise you of the technique that is proposed since facelift surgery is not a single technique and needs to be tailored to the individual. 

There are many techniques available for effective facelifting.  Most , if not all, involve cutting the retaining ligaments to allow better redrapage of the skin.  

In many cases, retaining ligaments need to be released to improve the overall results.  Each case is different so you will need to discuss with your Board Certified Plastic Surgeon.

The facial "ligaments" aren't ligaments in the same fashion as we see in the extremities, but dense fascial connections connecting skin to deeper soft tissues (SMAS) and then to bone. These consist of zygomatic cutaneous and mandibular cutaneous ligaments, which are typically released or divided in order to adequately allow for repositioning of the SMAS.  A more superficial structure, the parotidocutaneous ligament, is released on elevation of the initial skin flap.  These ligaments aren't necessarily recreated, but elevation and securing the SMAS with suture is the foundation of a SMAS  based facelift. The way I describe this to patients is that the SMAS is the "carpet liner" on which tension is placed so that the skin, or "carpet" can be trimmed without tension.  

Hi and thanks for the question. Facial " ligaments " are not true ligaments in the sense that they do not connect bone to bone. For the purposes of this audience, they do represent a complex system of soft tissue support in the face. During a facelift surgery, some of these ligaments can be strategically released -  this allows for optimal redraping of the skin. The ligaments are not reattached, but rather, skin attaches to the underlying SMAS during the healing process.Best of luck,Doctor Vallecillos, MD, FACS, Board Certified Plastic Surgeon

Depending upon the technique and the facial anatomy, certain ligaments near the chin and in the cheek are often divided to allow certain tissues to move more easily.

Thanks for your question.  The significance of the facial retaining ligaments depends on the plane in which your plastic surgeon lifts your face.  If the surgeon is doing the lift in the plane underneath a fibrous layer known as the SMAS, he or she must release certain bands of tissue that connect the SMAS to deeper layers.  Otherwise there won't be much of a lift when the SMAS is pulled into a higher position.  Another approach is to carry out the lift in a more superficial plane, in which case there is no reason to release these ligaments.  I have done lifts in a wide variety of planes, everything from just above the bone, to under the SMAS, to the more superficial plane.  In most cases I prefer the superficial plane because it gives me the most flexibility in shaping the face in various ways.  That said I have many friends who routinely do subSMAS lifts and get beautiful results.  Best of Luck

Thanks for the question.  The ligaments that you are referring to are soft tissue attachments, not true ligaments that hold bone to bone.  There is a mandibular ligament and zygomatic ligament, and release of these enables a release of the soft tissues to give you a better "lift" during a facelift surgery.  They do not need to be reattached after releasing them.