Can Face Lift Fail Because Sutures Are Absorbed to Quickly?

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.

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