Permanent or dissolvable stitches for SMAS facelift success?

Question

Hello, I recently had an SMAS mid and lower face lift and necklift overseas, my surgeon used dissolvable stitches of 6-8 weeks, I have just read on real self of surgeons using permanent stitches on the SMAS as they offer longer lasting results, now I am concerned mine will not last? After spending so much money and the stress of the operation I would be very disappointed to learn that this may be the case, opinions please, thank you so much :)

Alejandro Nogueira, MD · Answer

The fact that stitches are dissolvable or permanent changes NOTHING about the duration of the lift effect, the lift is made by the pulled up SMAS healing in the right place, stitches just bring things together but hold nothing; in fact, I do regularly face and neck lifts dealing with SMAS flaps and platismaplasties, and I think permanent stitches are not only unnecessary but a terrible mistake, they are touchable, painful and even visible under the skin of face and neck few months after surgery, or even may extrude through cutaneous fistulas.

Marc DuPéré, MD · Answer

Thank you for your question about SMAS Facelift and the anchoring sutures.Most important are your plastic surgeon's experience and technique and your compliance.Most longer-lasting sutures start loosing their strength after 4 weeks and many of our patients are anxious to get back to some "more normal" life post facelift surgery.  For these reasons, I tend to use the permanent ones for 2 or 3 strong anchoring sutures at key locations and the rest I use the dissolving sutures such as PDS.  There is less risk of the soft tissue SMAS relaxing too prematurely.I've had 2 painless permanent sutures poking through the skin over 14 years, behind the ear, and those were easily removed in a few minutes, in-office, under local anesthesia with no recovery needed and no compromise in the facelift result.So I feel the rare stitch sticking out is a smaller concerns than loosing the SMAS lift after 4 weeks with my very active Toronto patients.This may be different in different parts of the world!Dr MarcDuPere, Toronto Royal College Board-Certified
plastic surgeon

Jonathan Kulbersh, MD · Answer

The most important factor in getting a great result from a facelift is the surgeon you choose.  There are a great variety of techniques and nuance of these techniques that exist.  One of these details is the type of stitches used to hold the SMAS in place after the lift.  Surgeons can either use temporary or permanent stitches in this situation.  As long as the stitches last a few months, I do not believe the type of suture matters.  The stitches are holding the lifted tissue in place until scar tissue forms.  At that time, the scar tissue will hold the tissue in place.  The one negative aspect of permanent stitches is they may break through the skin overtime and have to be removed.  For this reason, I use long lasting permanent sutures to secure the SMAS during a facelift.  I hope this helps.

John J. O'Brien, MD · Answer

Hello, and thank you for this question. I agree with several of the other surgeons that did not feel this was a major consideration. Although commonly we will use non-dissolving sutures to elevate the smas, with a good lift and excellent skin support you will do just fine. Certainly what will help your result is continued attention to good skin care to try to improve your native elasticity.

Steven L. Ringler, MD, FACS · Answer

Thank you for your question. Many surgeons use dissolving sutures in a facelift. Some types of these sutures take up to 3 months to dissolve. By this time all of the important healing is done and the need for suture support is over. I use to use permanent sutures but switched to absorbable ones several years ago, with no change in the excellent results. I would not be concerned about the type of sutures used in your case.

James Bonaparte, MD, MSc, FRCSC · Answer

In all surgey, this will be a question for the ages. We all have our opinions as to what the best suture is. If I can give you some piece of mind, many very successful surgeons use dissolving sutures. Sutures we use can last a long time. Eventually, the sutures (even if permanent) dont have the same pull. Scar tissue forms and this helps your facelift stay in place. I am sure things will be fine. James P. Bonaparte, MD, MSc, FRCSCHead and Neck Surgerypracticing in Facial Plastic and Reconstructive SurgeryAssistant Professor, University of OttawaOttawa, Ontario, Canada

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