Facelift with sutures or with no sutures? Please help

Simply put, each surgeon's technique varies based on their own experience and preferences and my use either permanent sutures or dissolvable sutures. Generally speaking, surgeons who use permanent sutures believe that these sutures provide a lasting "lift" by securing the tightened tissue in place permanently. Dissolvable sutures would begin to degrade over time and rely on the body's ability to hold the lift in place with scar tissue. There are, of course, pros and cons of each technique with a very rare chance of foreign body reaction against permanent sutures in the form of nodules or granulomas and lack of longevity of result with dissolvable sutures. I have had good success with both approaches, and I would tailor said approach toward each patient individually based on their anatomy, desires, and concerns. I would recommend you seek guidance by a board certified plastic surgeon with experience in facial rejuvenation.

Dear Andrea,

Thank you for your excellent question.

Many facelift techniques, such as the SMAS facelift, MACS lift, Deep plane, and others, indeed involve the use of sutures to reposition facial tissues and achieve the desired results. Typically, surgeons use permanent sutures to suspend the SMAS (superficial musculoaponeurotic system) to maintain the lifting effect over time.

If you have concerns about the use of permanent sutures, it's crucial to have an open and thorough discussion with your surgeon. There are alternative options available, such as dissolvable sutures that take longer to resorb. These dissolvable sutures can be considered in your case, offering a potential solution that aligns better with your preferences and requirements.

In short- every surgeon's practice is different..1. Regarding sutures- the vast majority of surgeons will use sutures in the deeper layers of your face while performing a facelift, though the exact selection of suture type can vary. Some surgeons use "permanent" and some use "dissolving" or "temporary" sutures for these deeper layers. The reason for these sutures is typically to plicate (tighten) the SMAS layer, a fibromuscular layer which is is tightened to improve the aesthetic appearance and longevity of results with a facelift (compared to skin resection alone). I would not be so worried about these deep sutures, as many surgeons generally consider them necessary to achieve a good result, and you will likely be thankful they dod use them.2. Regarding the anesthesia- although some surgeons prefer putting patients fully asleep under general anesthesia for this procedure, some perform it under IV sedation ("twilight sedation") with local anesthesia, or just under straight local sedation, as you are describing here..Everything ultimately comes down to surgeon and patient preference, so always have the conversation with your surgeon so you both know exactly what to expect, and so you both feel comfortable with how the procedure will be performed prior to proceeding. Hope this helps!.Best, Dr. Donald Groves Plastic Surgeon

I recomen to speak with your board certified plastic surgeon about your concerns. Current techniques avoid tension on the deep planes resulting on log lasting results; this can be done with permanent sutures as well. Anesthesia can be local + sedation or general, both are safe and this will depend on what your surgeon feel most comfortable to reach the best result in a safer way according to your specific case.

There are options which you could choose for your facelift surgery. These should be discussed with your surgeon so all can agree the best path forward for you. For anesthesia, this can be either local with sedation or general, whichever you would be most comfortable with. If you were only having a mini facelift, local anesthesia with sedation would work very well. If you’re having a total facelift and neck lift with suturing of the platysma muscle and the SMAS, you may find that your experience is better under general anesthesia. Check with your plastic surgeon to see which they recommend. The sutures which are placed underneath your skin, are meant to elevate and smooth your SMAS layer. The SMAS is the support structure in your face, just under your skin, and needs to be sutured upward and posteriorly in order to straighten your jawline and contour your neck. While permanent sutures could be used, I prefer using a long, lasting, dissolvable, suture, which assures me that eventually they will dissolve and not be a concern. Best wishes.

Hello,
Thank you for your question. I don't blame you for being confused by alll of the information out there. Pretty much every facelift uses sutures of some kind - either permanent or dissolvable. I've used both in the past and currently favor permanent sutures because I like having the added support after dissolvable sutures would have dissolved. If you bury the permanent sutures under your own tissue, infection or extrusion is unlikely. As you mentioned, facelift can be done wide awake using local anesthesia and oral medications to help you relax. Patients do incredibly well with this and it avoids the side effects of general anesthesia.
Mark G. Albert, M.D., F.A.C.S.New York, NY

Modern Facelift techniques involve manipulation of the SMAS layer, which sits beneath the skin, placing tension of the SMAS with long acting monofilament sutures, and trimming redundant skin. I perform a deep plane facelift, which allows for mobilization of SMAS and skin in what is called a composite flap, for a very natural but significant result. I prefer to utilize sedation for my deep plane facelifts, which take about 3 hours of operative time. This is too long a procedure to perform under local anesthesia.

I completely understand your concerns. The approach to facelift surgery can vary among different surgeons. In my practice, I prioritize your safety and natural results. I avoid the use of permanent foreign bodies and instead opt for absorbable sutures that are long-lasting (6-9 months) for the tissue repositioning. Your body forms natural scar tissue during this period, so I don't think permanent sutures are necessary. But I know some of the best surgeons in the world who argue for permanent sutures. Either way, they are both designed to be safely left in the body. As for anesthesia, I tailor the approach based on your comfort and the complexity of the procedure. Both local anesthesia with sedation and general anesthesia are viable options, and I recommend the most suitable one for each individual case.

Hello, hope you are well. The most common facelift techniques involve placing sutures deep beneath the skin to hold tension off of the skin closure while healing. Surgeons vary--some use absorbable sutures and some use non-absorbable. Some select the suture material based on patient factors. If it concerns you, ask your surgeon their reasoning, or request absorbable suture material.
Best,Dr. Tower

Many facelifts entail the use of permanent sutures to tighten the muscle. These suture rarely cause a problem. A facelift can be done either with general anesthesia or local with sedation. It friends on the surgeon and patients preference