Consideration of Facelift Methods and Facial Retaining Ligaments in Asians

The demand for facelifts is rapidly increasing in Asia because of economic development as well as the aging of the population. It is difficult to achieve satisfactory results, because of the facial characteristics of Asians. The goal of the facelift is to improve facial sagging. During initial stages, facelifts focused on the lower face. Various approaches, such as the extended superficial musculoaponeurotic system (SMAS) facelift, the finger-assisted malar fat elevation (FAME) facelift, and the high SMAS facelift, were designed to improve facial sagging in the midand lower face with the development of advanced facial surgical procedures [1-5]. Retaining ligaments is important for facelifts and was described by Furnas in 1989, because these ligaments support the soft tissue in its normal anatomical position and resist gravitational effects [6]. These structures attach the dermis, SMAS, and subcutaneous tissues to deep structures such as underlying muscle, bone, and parotid glands. There are two ligament systems. The first comprises true osteocutaneous ligaments: the orbital, zygomatic, and mandibular ligaments. The second involves tethering structures that do not originate from bone but attach the SMAS layer to the deep fascia: the parotid cutaneous and masseteric cutaneous ligaments. With aging, attenuation of retaining ligaments leads to the gravitational Min-Hee Ryu