Can Face Lift Fail Because Sutures Are Absorbed to Quickly?

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.

Doctor Answers 24

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 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.

Dallas Plastic Surgeon
5.0 out of 5 stars 64 reviews

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.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Facelift sutures are not the problem

I personally don't feel that the type of suture is all that important. Once the deeper tissue is lifted, it only has to stay there a few weeks before the healing process will keep it there forever. More than likely, a technique of facelifting was performed that was inadequate for your particular anatomy.
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

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

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.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Facelift Sutures

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

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 85 reviews

The results more depend on the surgical planning than the sutures

I use absorbable sutures and never had such a issue. i have had few cases that results were not up to my expectation and required redo . Please talk to your surgeon and do start with blaming your surgeon. i would suggest that you discuss your expectations and you may need to have revision. Your surgeon should charge for the revision and you should pay for the anesthesia and surgery center fees.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Does Suture Material Matter for Facelift

Though possible I doubt that in most cases the type of sutures matter. I have been doing facelifts for more than 25 years. I started with permanent sutures in the SMAS then switched about 13 years ago to absorbable sutures and have noticed no difference. The skill of the surgeon, technique, elasticity of the skin and SMAS, general health of the patient, smoking history, all play a role in the final results and their longevity.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

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.

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 80 reviews

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.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 211 reviews

Do Absorbable Sutures Work for Facelift Surgery

Yes, absorbable sutures absolutely work! Personally, I only use absorbable sutures. By the time they melt away (about 3 months or so), the facial tissues have found their new place and don't rely on stitches holding everything up. Inappropriate would be fast-absorbing sutures (such as gut sutures) but do not think your surgeon would use this suture material for a facelift.

Therefore, I doubt your disappointment is a result of sutures failure. If your before and after photos do not show a difference, then it rather represents a technical issue related to surgery.

The face always looks a little tighter initially (first 2 to 3 months) but the result truly counts after 9 - 12 months. Your experience is one that we sometimes hear after thread-lifts, silhouette lifts or mini-facelifts. I would talk to your surgeon.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 49 reviews

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.