Retaining ligaments of the nose: A cadaveric study in Asians

Background: This study aimed to identify the anatomy of retaining ligaments in the nasal region and understand their function via dissection of Asian cadavers. Methods: Between July 2020 and May 2023, 19 cadavers—11 fresh-frozen Koreans and 8 formalin-fixed Japanese—were examined. A midline vertical incision was made from the glabella to nasal tip, allowing exploration of supra-periosteal and supra-perichondrial planes. Vertically oriented, firm ligamentous structures connecting the nasal framework to the overlying skin-soft tissue envelope were carefully observed. Results: In all cadavers, 3 distinct retaining ligaments were consistently identified and named as superior, middle, and inferior nasal retaining ligaments. The superior nasal retaining ligament attached to the nasal bone at the level of the canthus, whereas the middle nasal retaining ligament attached at the nasal keystone area. The inferior nasal retaining ligament, also known as the vertical scroll ligament, connected the nasal superficial musculoaponeurotic system to the junction between the upper and lower lateral cartilage. Conclusions: Three nasal retaining ligaments observed and named in this study are fibro-ligamentous structures originating from the periosteum and fascia, supporting nasal shape, skin, and soft tissue positioning. Release of the nasal retaining ligaments would enable lengthening and augmenting the entire nasal structure for achieving successful outcomes in Asian rhinoplasty.