Difference Between Types of Stitches for Facelift?

If a doctor uses a rolling stitch, instead of the very fine sutures I have seen used by some physicians for facelift incisions, is it more likely to leave a visible incision? Does it make a difference on what day post-op the sutures are removed? Thank you.

Doctor Answers 22

Factors that effect face lift scars

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It does not matter what type of sutures are used on a facelift. One of the three most important things regarding the incisions for a facelift is placement of the incision. Where the incision is placed initially is a very critical factor as to how it will heal. The second critical factor is tension placed on the skin. Wide glide scars ensue when too much tension is placed on the skin, which causes a wind tunnel look. The third most important part of the facelift incision is that the sutures are removed very early to prevent railroad tracking on the incision. In our practice, the sutures on a facelift are all removed on day four so that there is no railroad tracking on the incisions.

Facelift stitching technique

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The particulars of what type of stitch your surgeon uses are not as important as the skill and experience he/she possesses. Standard techniques include what you have mentioned. As long as undue tension is avoided and fine (5-0 or smaller) sutures are used, and removed in a timely fashion (a week or so or less), the wounds should heal well. In addition, the wound care the patient provides (after instruction) is equally (if not more) important. At this time in my practice, this includes cleaning the wounds with saline or peroxide/saline, and dressing with petroleum and/or antibiotic ointment twice a day.  

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Effect of sutures on facelift scars

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It is important how sutures are placed, and how much tension is used to close the incisions. Sutures should be removed as soon as possible, but not too quickly so the wound falls apart. Buried sutures in some places tend to produce better healig that sutures placed in an over- over fashion. However sutures must sometimes be placed individually in very tricky areas such as the earlobe, especially if the earlobe is being changed and reconstructed.

Unless you actually become a plastic surgeon, it will be difficult to ask meaningful questions about suture choice and placement. And every plastic surgeon has their own style.

A top plastic surgeon will choose the best sutures given their experience.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

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The suturing technique isn't the important consideration between facelift surgeons

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There are many ways to close the skin and as long as the stitches are done without undue tension and are removed in a timely fashion, the exact details of the suture material and technique should not be of great concern to you.

Suffice it to say, the best facelift surgeons all know how to sew the skin well. It is these doctors whom you want - after all, it's the only face you've got and it is not the time to go for a discount surgery.

Stitches in facelifts

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Different types of sutures are used by different surgeons and also in different parts of the face.  In front of the ear, I like to use fine hidden sutures that won't leave stitch marks.  Less important in areas where the hair will cover the scars.  Believe it or not, many surgeons use staples in facelifts.

Face Lift Types of Sutures Importance

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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. Great surgeons get great results more often even though their suture technique may vary.

Different stitches in a facelift

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The type of stitch used and the technique is very surgeon dependent. Each person has a protocol and so my best advice is to relay your concern to your surgeon and follow his/her advice.

Facelift incisions

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Plastic Surgeons will use several different kinds of suture techniques, and they rarely have a detrimental effect on the appearance of the scar.  The sutures should not be left in too long (over 10-14 days) in order to avoid leaving marks.  The technique of the face lift is more important than the suture with respect to the result in the face and the incision- avoiding excess tension on the skin is the most important factor in postoperative scarring.

Different suture techniques

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as long as the running over and over stitch is not pulled too tightly and it is removed at the same day post-operatively, there should be no difference in the quality of the scar.

Different types of stitches for facelift

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Each surgeon performs skin closures in a different manner according to his or her personal preference and personal results. In general, interrupted or continuous sutures may be placed using thin sutures. These sutures are placed without tension and are usually removed at about 5 days post-op. The method of skin closure may vary epending upon the use of subcutaneous absorbable sutures at strategic locations.

There are some surgeons that use dissolvable sutures and some surgeons even use a tissue glue on the surface instead of sutures. There are pros and cons of all these techniques. I tend to use continuous (running) interlocking 5-0 non-absorbable nylon sutures placed without tension for closure of the facelift skin when placed in front and behind the ear. The sutures are removed on the 5th or 6th post-operative day in most cases.

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.