Overview
Complete release of the retaining ligaments is essential for durable deep plane face and neck lift results, but facial nerve branches run close to these ligaments. Surgeons currently rely on uncodified visual and tactile clues, or on separate nerve monitoring that requires an instrument change. The authors propose a structured three-sign sequence performed with one instrument. The abstract reports no patient data.
Findings
- Sign 1, Visual Assessment Test: checks fiber direction and tissue character.
- Sign 2, LigaSure Tweak Test: separates nerve, which responds, from ligament, which does not.
- Sign 3, Skin Tethering Test: gentle traction confirms the ligament's attachment to the skin through visible dimpling.
- A structure is divided only when all three signs point to ligament.
- The LigaSure vessel sealing system serves as both probe and dividing instrument, so no instrument change is needed.
- The framework combines previously described clues into a structured, teachable approach.
- Ligament release is described as the most challenging step of deep plane facelift.
What it means for a patient
- In a deep plane facelift, the surgeon must cut ligaments that sit near the nerves that move the face.
- This method adds a three-step check before each cut to lower the chance of cutting a nerve.
- Limits: a technique description. The abstract gives no nerve injury rates or comparison with other methods.
Why this paper matters
It turns separate ligament identification clues into one sequence that can be taught and repeated, using a single instrument. Whether it lowers nerve injury rates is not shown in the abstract.
Terms
- Retaining ligaments: fibrous bands that anchor facial soft tissue to deeper structures and skin.
- Deep plane face and neck lift: a lift that frees and moves the skin and deeper SMAS layer together.
- LigaSure: a brand of device that seals and cuts tissue using electrical energy.
- Facial nerve branches: nerves that control the muscles of facial expression.
- Neuromonitoring: equipment that detects nerves during surgery by stimulating them.
- Skin tethering: the skin dimpling when a ligament attached to it is pulled.
- Dermal insertion: the point where a ligament attaches into the skin.