Resumo

Objectives: The layered anatomy of the face includes ligaments like the zygomatic cutaneous ligament, essential for skin stability. This study provides the first in vivo visualization of the zygomatic cutaneous ligament, revealing it as a stable structure with horizontal lines, challenging prior cadaver-based descriptions. Introduction: The layered anatomy of the face includes ligaments like the zygomatic cutaneous ligament, essential for skin stability. Most knowledge on these ligaments comes from cadaver studies, which are limited by post-mortem changes that alter tissue structure and behavior. This study uses ultrasound to provide the first in vivo visualization of the zygomatic cutaneous ligament, examining its structure and characteristics across demographics (e.g., gender, age, BMI, ethnicity) to deepen understanding of its role in facial anatomy and aging. Materials / method: This observational study at Erasmus Medical Center used ultrasound imaging to analyze the zygomatic cutaneous ligament in participants who had not undergone any prior facial procedures. Demographic data were collected, and ultrasound measurements assessed ligament depth, width, and position. Results: Measurements were consistent across probe positions and facial sides. Women showed significantly greater ligament depth and more superficial fat than men (both p < 0.001), with no differences in ligament width. BMI correlated with bizygomatic width (r = 0.46, p < 0.001) and superficial fat (p = 0.039) but did not affect ligament dimensions. No significant age-related correlations were observed. Conclusion: This study provides the first in vivo visualization of the zygomatic cutaneous ligament, revealing it as a stable structure with horizontal lines, challenging prior cadaver-based descriptions. The ligament’s consistency across positions and demographics highlights its role as a reliable anchoring structure, while gender differences point to distinct facial architecture. Future research with diverse populations and advanced fat analysis, advancing facial anatomy and aesthetics is needed.