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Abstract Background: Facial rejuvenation constitutes only one aspect of facelift-surgery. Another, often underestimated central challenge of facelift-surgery is to maintain the patient’s facial-identity. Therefore it is important to identify the main anatomical determinants of facial-identity. Their recognition impacts on designing optimal facelift-surgery techniques. Objective: To identify which structures in human facial anatomy, that are accessible to facelift surgeons, play a central role in determining a patient’s personal facialidentify. Methods: First, the master anatomical constituents of human facial anatomy are reconsidered. Second, it is evaluated which of these constituents are important for identity-determining facial expression. Third, from frequent undesired results of well-defined standard facelift-surgery techniques it is concluded whether or not dissection of a given anatomical constituent is important for conserving facialidentify. Results: On this basis, we argue that retaining ligaments and the inter segmental connections of the Superficial-Musculo-Aponeurotic-System (SMAS), which tether, structure and compartmentalize facial soft tissue, are the key anatomical determinants of human facial-identity. Conclusion: Optimal facelift-surgery should strive for conserving a patient’s facial-identity. In order to achieve this, retaining ligaments should be preserved and therefore the superficial-musculo-aponeurotic-system (SMAS) will be only dissected related to the tissue-layer main interconnections keeping the retaining ligaments and the related layers connected during surgery.

Anatomical Determinants of Facial Identity: The Central Importance of Retaining Ligaments and SMAS