Is it better to use absorbable or non-absorbable sutures? My SMAS failed. Nothing ever tore. Nothing sagged non-symmetrically, just none of the suture anchoring worked. pre and three month post op pictures of neck and jowl are the same. For the first 4 weeks post op when there was swelling, it appeared as if the neck and jaw line were great.
Can Face Lift Fail Because Sutures Are Absorbed to Quickly?
Doctor Answers (24)
Suture technique may be very important for your result
In contrast to some of the other replies to this question, I believe that suturing technique does play a role in your result. It may not be more important that your anatomy, skin characteristics, and genetics, but I do believe that there is a difference depending on the suture used and the technique. I have operated on a large number of patients who had facelifts done in the past. In the large majority of these patients, the skin had been pulled very tight, but the foundation of the face was very loose and there was no evidence of old sutures. In these cases, I suspect that a dissolvable suture was used. I was trained by a surgeon who not only used a permanent suture, but also placed a large number of them. During my training, I had the opportunity to operate on several patients who had facelifts done 10 to 15 years earlier. When doing the surgery, the old sutures were seen, but they continued to offer some support to the foundation. The foundation did age around these sutures, but it had not fallen apart like a number of patients who received their first surgery elsewhere. Consequently, I only use a permanent suture with a lot of reinforcement as I feel that prolonged support of the facial foundation may lead to a better, longer-lasting result that a dissolvable suture.
Facelift Longevity: Technique Dependent
There are many facelift techniques, and not all can deliver long lasting results. The result depends on the patient and the quality of tissue, the technique and on what structure the lift was supported and more importantly how much tension was placed on the structure. It is known that skin only lifts have a high chance of recurrence, as well as just suture suspension of the SMAS. It is likely you did have most of your "lift" placed on the skin and permanent or absorbable, both will fail early. Properly dissected SMAS, with moderate tension placed on it should provide a long lasting result.
I use permanent sutures for SMAS and muscle tightening in Facelift surgery
I use non absorbable permanent sutures to tighten the SMAS and muscles beneath the skin during Facelift surgery. I know these sutures will hold my correction for many many years. I have found these permanent sutures still intact holding muscle after 18 years when performing a secondary Facelift after the skin overlying the sutured area had aged and sagged again.
Theoretically even with non absorbable sutures used in SMAS and muscle tightening, the tissue planes should heal tightly in place and the correction be maintained. Many surgeons use only absobable sutures and get excellent long lasting results.
It is more likely that the skin undermining and SMAS and muscle tightening was inadequate and the skin laxity has relapsed.
However I feel more secure about the longevity of my Facelift results using permanent sutures for SMAS and muscle tightening.
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Fast absorption of sutures after Facelift
Yes, but it's more likely that the SMAS was folded on itself using dissolvable sutures instead of undermining, trimming, lifting and re-suturing the SMAS back together...which is the preferred method of dealing with the SMAS IMHO. I use dissolvable stitches that last several months which is long enough for scar tissue to support the lifted tissues. Inadequate skin removal is another reason that things may appear to have fallen so soon after the Face Lift.
Sutures failing during facelift?
Suture breakage or failure would be an uncommon reason for a facelift to fail.
In principle, when we do a facelift, we have to:
1) free up the SMAS and skin appropriately
2) fully release tethering ligaments which prevent the tissues from moving,
3) reposition the SMAS and skin appropriately, (back to where it used to be)
4) hold them in the right positions until it all heals.
5) hope that the tissue quality is sufficient to maintain this result.
Of all of these steps, #4 is the easiest. I suspect it was something in the other 4 areas that might have been a problem.
I suspect the problem in your facelift is from one of the other steps.
Reason for unsuccessful facelift
Although proper suture placement is important, sutures alone are likely not the only reason for your result. These are some of the questions that come to my mind: 1) was a proper surgical plan developed to adequate treat your signs of aging, 2) was proper underming performed; 3) was the SMAS treated correctly; and 4) was facial volume/hollowing addressed properly. Please talk with your plastic surgeon to have your concerns addressed.
Facelift sutures are not the problem
I would recommend discussing your concerns with your surgeon. If a better technique is available, consider a revision facelift. If there is only one technique that surgeon performs, you may want to get a second opinion. There are some very advanced tecniques of facelifting that can create very elegant necklines, even in very challenging patients.
Andrew C. Campbell, M.D.
Board Certified Facial Plastic Surgeon
Preventing sag: Absorbable or permanent sutures (stitches) for face lift: Crude analogy offered to explain
The use of sutures and techniques to achieve correction of facial sagging are very important. However, if the long term results depend on the suture than the wrong technique was used. Generally speaking sutures hold things in place until the healing of the tissues can take over the work of the sutures which need to remain present for as long as it takes to heal for the critical portions of the procedure. Thereafter the permanency of the sutures should be irrelevant. If this sounds too abstract, here is a crude analogy: when tree limbs are grafted to one another, they are initially held together with permanent material such as duct tape becasue masking tape would not do. If you remove the duct tape the next day, the branches will fall apart. After 6 months the tape is essentially useless because the tree limbs fall apart.
Why Facelifts Fail- 3 main Reasons
Facelifts fail to work for 3 main reasons
1. The Facial aging process was not addressed with the technique used. For example, if you do skin only facelift for advanced facial aging..........it will fail long term .
2. Not enough Deep layer lifting or manipulation was done on the SMAS. If you want longevity in a facelift, you need to alter the deep layers .
3. Did not address the true cause of the aging process. This is very common in which only a FACIAL TIGHTENING procedure was done and not a FACIAL FAT RESTORATION . It is important to do both a LIFT AND FILL type of facial rejuvenation for more natural long term results
Sutures play an important role in how you strengthen the SMAS layers but are not usually the ultimate cause of failure of Facelift surgery in most patients.
If you do not see a change at 3 months, this problem has nothing to do with the type of sutures, but everything to do with the surgical technique utilized. A properly executed facelift should deliver long lasting results. Issues to take into consideration.
1. Did a suture loosen or pop? Unlikely if both sides are loose
2. Do you smoke? Smoking can significantly shorten the longevity of a great facelift
3. Do you have excessive sun damaged skin? Although we can reposition and reshape the skin and muscle of the face, if this tissue is already badly damaged, the result will be much shorter lived than healthy skin
4. Do you have excessive Face and Neck fat? If you have excessive fat in the face and neck that is not addressed in the facelift, the result will stretch quickly. This is similar in concept to doing a tummy tuck by simply tightening the muscle and removing overhanging skin, you will still be left with a thick bulging abdomen.
Hope this helps and all the best in your revision procedure.
Paul S. Gill, M.D.
Houston Double Board Certified Plastic Surgeon
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.