{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:40:32Z","timestamp":1787841632469,"version":"build-2784847793"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR 002384"],"award-info":[{"award-number":["UL1 TR 002384"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Facial retaining ligaments (RLs) are well\u2010characterized for their role in soft\u2010tissue support and in rhytidectomy. This study investigates whether RLs also act as anatomical barriers that influence the spread of basal cell carcinoma (BCC). We hypothesized that the dermal insertion of RLs impedes the dermal spread pattern of BCCs, specifically causing them to grow along the RL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 163 patients who underwent Mohs micrographic surgery (MMS) for BCC. Post\u2010MMS defects were used as a proxy for the BCC size and shape. The defects were categorized as \u201cnear,\u201d \u201cfar,\u201d or \u201ccrossing\u201d based on their proximity to the RL. Defect symmetry was quantified using the perpendicular\u2010to\u2010parallel ratio of the defect relative to the RL. A relative proximity ratio (RPR) was used for continuous linear regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analysis revealed significant defect asymmetry in lesions near RLs. The \u201cnear\u201d group demonstrated a growth pattern parallel to the RL (ratio of 0.73) compared to the \u201cfar\u201d group (ratio of 0.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Linear regression confirmed that RPR was a predictor of tumor growth parallel to the RL (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.099,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Only 5.5% of lesions breached the RL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RLs correlate with an eccentric, oblong BCC growth pattern parallel to the direction of the ligament. Recognizing lesions within these zones may improve preoperative counseling and reconstructive planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70480","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:55:59Z","timestamp":1784721359000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Facial Retaining Ligaments Influence Basal Cell Carcinoma Growth in the Midface and Periorbital Region"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3629-715X","authenticated-orcid":false,"given":"Margareta","family":"Morrissette","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Weill Cornell Medical College  New York New York USA"},{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Columbia University Vagelos College of Physicians and Surgeons  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Hua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandita Varma","family":"Vegesna","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Columbia University Vagelos College of Physicians and Surgeons  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kira","family":"Minkis","sequence":"additional","affiliation":[{"name":"Department of Dermatology Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7875-4847","authenticated-orcid":false,"given":"Anthony P.","family":"Sclafani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5342"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102133.2010.09809.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1997.03890410049006"},{"key":"e_1_2_10_5_1","first-page":"195","article-title":"Basal\u2010Cell Carcinoma and Squamous\u2010Cell Carcinomas: Epidemiology, Location and Radiotherapy","volume":"11","author":"Dourmishev A.","year":"1996","journal-title":"Skin Cancer"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/2229\u20105178.105456"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(04)17399\u20106"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u20104725.1989.tb03249.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.135.10.1177"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.abd.2020.10.004"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X13495405"},{"key":"e_1_2_10_12_1","unstructured":"ProQuest \u201cAnatomic Study of the Retaining Ligaments of the Face and Applications for Facial Rejuvenation \u201daccessed April 29 2024 https:\/\/www.proquest.com\/docview\/1355294078?parentSessionId=IvcMc7x46kcjS4TwGQonzCxgZbcHoericbQyTs0uXmY%3D&pq\u2010origsite=summon&accountid=10226&sourcetype=Scholarly%20Journals."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000021442.30272.0E"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009975"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010200209010\u201000026"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200105000-00039"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010012\u20109995\u2010x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60050681"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008716"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.2011.1533"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200004000-00035"}],"container-title":["Laryngoscope Investigative Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.70480","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lio2.70480","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.70480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:16:03Z","timestamp":1787840163000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lio2.70480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/lio2.70480"],"URL":"https:\/\/doi.org\/10.1002\/lio2.70480","archive":["Portico"],"relation":{},"ISSN":["2378-8038","2378-8038"],"issn-type":[{"value":"2378-8038","type":"print"},{"value":"2378-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"assertion":[{"value":"2026-04-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70480"}}