Takeaway: Because you manipulate skin ligaments with every massage stroke, understanding them better can help you be more specific with your touch.

Between the skin we touch and the muscles we palpate lies a world of tissue and activity that is often under-addressed in our anatomy books, including one extraordinary structure we massage every day called the skin ligaments (retinacula cutis). These are made of connective tissue and part of the fascial system, but unlike most of the other ligaments you know, skin ligaments do not connect bone to bone. These small, fibrous structures create a bridge connecting the skin’s dermis to the deep fascia—and you move them with every massage stroke.

Where Do They Live?

Skin ligaments can be found everywhere within the body’s cushiony outermost layer—the subcutis, which is also called the subcutaneous tissue or superficial fascia. The subcutis is the dynamic space situated between the dermis and the deep fascia that stores energy, regulates temperature, exchanges hormones, and circulates lymph. In order for this busy community of cells and fluids to do its job, it requires a stable structural network to live in, which is formed by none other than the skin ligaments.

What Do They Look Like?

The architecture of the subcutis is immediately visible in the anatomy lab once we go beneath the skin. Our eyes are first drawn to its most striking feature: billowy, bright-yellow fat lobules (Image 1).

Looking closer, we can see skin ligaments extending down from the dermis, between the fat lobules, defining their shape and forming a fascial framework that resembles honeycomb or bubble wrap. You’ve probably seen skin ligaments before, even if you haven’t been in an anatomy lab. Have you ever seen cellulite? As much as our culture may lead us to believe cellulite is a pathology, it is nothing more than the visible impression of your skin ligaments and fat lobules on the skin’s surface.

What Do They Feel Like?

Skin ligaments vary in thickness and density regionally and give structural boundaries to the fatty lobules. Areas that require more stability have shorter, denser, more tightly packed skin ligaments, such as on the palms, soles of the feet, and sacrum. In these areas, the ligaments and lobules can feel like small, squishy, tapioca pearls (1–2 millimeters). Areas that need to accommodate more internal or external movement between the skin and deep fascia have finer, longer, not-so-tightly packed skin ligaments surrounding the fat lobules, such as on the abdomen and thighs. Here, their adaptability makes them less easy to palpate, but you may perceive their soft texture similar to the size and shape of mini marshmallows or candy corn (5–20 millimeters).

What Do They Do?

Skin ligaments serve a number of functions we would struggle to live without. Their containment of fat lobules provides a dynamic cushioning system that protects, insulates, and disperses force. The dividing walls in their “honeycomb” organization also protect nerves and blood vessels as they travel to the skin’s surface and prevent the fat lobules from floating around. The morphological variation of their presentation—density and thickness—in different regions gives them the capacity to allow for dynamic movement or resist mechanical loading where needed. Vital to the functions of the subcutis, they also permit passage of lymph fluids. In short, the cute little skin ligaments serve the many needs of your most superficial layer in relation to the complex structure that is you!

Why We Care

As massage therapists, every time we move the skin, we are also dragging the skin ligaments along for the ride. Understanding how they mechanically link the skin to the deeper body gives us a glimpse into the mechanisms at play in our most common massage techniques, particularly those that rely on shearing motions (Image 3). From effleurage to petrissage, we use shearing forces all the time in massage.

Since we influence so much tissue before ever reaching muscle depth, understanding the anatomy of the skin ligaments can help us be more specific with our touch and give us a deeper appreciation for what lies just beneath the surface. 

Let’s Explore

Check out the authors’ palpation exercise and get additional reading recommendations at abmp.com/anatomy.