Definition of Ligamentous Fibrous Tissue and Interethnic Differences: Caucasian Versus Asian

Abstract

This review redefines facial “ligaments” as fibrous pseudo-ligaments that compartmentalize and support facial tissues, enabling mobility and maintaining contour. Their density and tensile strength vary across facial subunits, critically influencing the outcomes of minimally invasive procedures like fillers and thread lifts. Significant interethnic differences exist; Caucasians often exhibit flatter malar eminences, while Asians tend to have broader faces with prominent zygomas, leading to divergent presentations of “sunken cheeks.” Consequently, procedural strategies must differ. For Asians, augmenting the sub-arch hollow refines contour and provides an efficient lift, whereas Caucasian patients typically require augmentation of the malar eminence and zygomatic arch itself. Effective treatment requires a biomechanical understanding of these ligamentous structures and their ethnic variations. Copyright © 2025 by Mutaz B. Habal, MD