Can Face Lift Fail Because Sutures Are Absorbed to Quickly?

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.

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.

Although I use permanent sutures, I feel that long-lasting absorbable sutures also provide a lasting support as the scar tissue is eventually what holds the lift up

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.

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
 

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.

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.

There are several different techniques regarding facelift, and I feel the most important is the strategy used on your particular face.  The type of suture, in my opinion, is usually secondary.

 

With a more limited facelift, it's common to use an absorbable suture that is actually anchored to bone.  With other techniques, the SMAS is tightened using permanent or absorbable suture, anchored to SMAS or bone or both.  The amount of tightening or pulling done on your neck muscles, jowls, and SMAS may also have an effect.  Finally, even so-called permanent suture isn't always permanent-  studies have shown that some of them actually absorb over many years.

 

So, depending on the techniques used on you as well as your facial structure, your result may not be as long-lasting as you wish.  I would consider talking to your original plastic surgeon, or seeking a 2nd opinion, regarding further tightening of the areas that you are diappointed in.  I wish you the best of luck!

This is a very good question, and my answer has two parts.  I do believe that the duration of result in the neck has some relationship to the type of suture used.  Because the platysma is a dynamic muscle, my impression is that recurrence of platysmal bands (the cords that form in the neck as one ages) is more likely to occur with absorbable than with permanent sutures.  For this reason, I use a Mersilene suture for the playsmaplasty, which is a form of braided Nylon. 

However, I believe that the result in the lower face is more related to the extent of SMAS elevation and mobilization than to the type of suture utilized.  Earlier in my career, I used a SMAS plication (folding over of the SMAS without lifting it), and was disappointed with the longevity of results.  Although the procedure is quicker, easier to perform, and has less downtime than SMAS imbrication (lifting up the SMAS and repositioning), I have found that the results with imbrication are better and last much longer.

I once heard a colleague state that, "every Facelift Surgeon is a hero at a month, the question is whether you remain a hero at a year".  Many patients who have indications for a true Facelift but opt to choose a mini-lift, or some form of branded lift are quite pleased at a month and find themselves underwhelmed at a year.

I am sorry to hear that the results were so short-lived. The longevity of your lift is likely related to the technique of the lift rather than the sutures. I would echo my colleagues advice to return to your surgeon and voice your concerns. Cosmetic surgeons truly want their patients to be happy. While we'd rather not have to experience less than optimal results it behooves all of us to do our best to give patients great results even in cases where a revision or touch up is required.Stephen Weber MD, FACS