A Novel Subclassification of Type 2 Dermal Insertion Structures.

Background: Current anatomical classifications inadequately represent dermal insertion structures critical to facial movement, support, and aesthetic outcomes. Particularly, Type 2 structures-defined by direct connections to the dermis-lack precise subclassification.

Objective: To introduce and validate a novel subclassification system for Type 2 dermal insertion structures based on their origin, composition, and clinical relevance in aesthetic and reconstructive procedures.

Materials and methods: Detailed cadaveric dissections (n = 20 hemifaces) were conducted to evaluate the microarchitecture and insertion patterns of muscles and ligaments associated with dermal anchoring. Structures were categorized into 4 subtypes based on anatomical origin and fiber composition.

Results: Four distinct subtypes were identified: Type 2a (muscle fibers directly inserting into dermis), Type 2b (muscle-collagen transitions), Type 2c (true ligaments anchoring dermis to bone or fascia), and Type 2d (retaining ligaments from intermediate layers). This classification enhances anatomical precision, improves procedural safety, and guides intervention strategies in injectable, thread-based, and surgical techniques.

Conclusion: The proposed Type 2 subclassification provides a clinically meaningful framework for understanding dermal insertions. It supports personalized aesthetic planning and dynamic facial rejuvenation by integrating structural anatomy with procedural targeting.