Facelift Sutures Permanent or Absorbable - How Do You Determine if a Facelift is Well Done?

If the sutures that stabilize the SMAS layers in their new position are dissolvable would that improve the longevity of the facelift? As the facial volume needs to be addressed properly for a good result, does it has to be fat transfer that achieve that volume or would replacing the SMAS layers give the same result. I am in the research stage for the right plastic surgeon so I will try to meet previous patients. How do you determine if a facelift is well done?

Doctor Answers 12

Facelift and Suture Choice

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I would not be that concerned about the choice of suture that a surgoen uses. I would focus more on the surgeon's experience and results. Some surgeons get outstanding results using absorbable sutures, some get great results with permanent sutures. Make sure to look at before and after pictures as well as patient testimonials in order to get a feel for the surgeon's work.

The risk to using permanent sutures is that they can potentially form suture granulomas which can be an annoying problem that may ultimately require some revision work. Absorbable sutures typically last up to a couple of months. By this point the muscle layer has scarred down in its more natural, youthful position and the sutures are not adding any benefit.

Newport Beach Facial Plastic Surgeon

The sutures used have not bearing on the quality of the facelift.

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It is generally important to stabilized the SMAS layers.  I personally like permanent sutures for this purpose.  However, many surgeons prefer absorbable sutures for this purpose.  The are concerned that long term there is a risk that the suture could become palpable or even become the nidus for a stitch access.  The reality is that for most patients sufficient scar tissue will form after surgery to function for the purpose of providing long term stabilization for the SMAS layer.  I personally favor the non absorbable suture because healing does take place over a long period of time.  It is likely that by week 6 or 8 when the absorbable sutures begin to weaken and break down enough scar has formed to hold the face.  However, it seems to me that the ideal situation, to avoid unnecessarily stressing the lift face by using a permanent suture that will continue to function even as the scar stimulate by the facelift continues to mature.  This biggest issues I see with facelifts are unnatural vectors of facial pull where the surgeon exceed the limits of tension that a face can support .  The other issue is a lack of tailoring around the ears to make the facial surgery scars as natural as possible.  Please be aware that board certified plastic surgeons may not be adequately trained in residency to perform a facelift.  You need to look beyond the credentials to find the right surgeon.  Talking with others who have had a facelift is a helpful approach.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

How do you determine if a facelift is well done?

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The best way to determine the success of a facelift is the way it looks, and if the facelift addresses the concerns the individual desired to rejuvenate. Visiting with board-certified plastic surgeons to discuss their approach and finding out the surgeons of individuals you know who had great results is the best way to pick a surgeon. You may also check out surgeons' websites to check their credentials, see what they offer educationally, and look at photo galleries.

With regard to your specific questions, some individuals do well with just SMAS tightening alone, and others may get a better result with adding fat grafting. Generally those who do well with fat grafting are more deflated, thinner patients. A fuller face does not require fat grafting. By the time absorbable sutures resolve, the face is healed, so it will not drop if the sutures dissolve.

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.8 out of 5 stars 57 reviews

Face Lift Sutures: Permanent vs Absorbable

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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.

Looking at before and after photos and recommendations from those you trust are helpful in selecting the right plastic surgeon for you.

Facelift Sutures Permanent or Absorbable - How Do You Determine if a Facelift is Well Done?

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Instead of focusing on the minute details of the surgical technique, I find it more positive to look at the before and after photos of the surgeons and discuss their individualized plan for you.

In other words, I would not find a technique, and then the surgeon. Find a surgeon you feel comfortable with and can trust, and then trust them to select the right technique for your specific needs.

As for determining if a facelift is well done: it should be rejuvenating but at the same time look natural. Achieving good results is often a lot more surgeon dependent than technique dependent.

Michael Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 41 reviews

Determining The Best Results from Plastic Surgeons

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     Try to find a board certified plastic surgeon with ELITE credentials and ELITE training who produces natural results time after time and performs hundreds of facelifts each year.  Kenneth Hughes, MD Los Angeles, CA

Well done face lift

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What makes a facelift appear 'well done' is when the result is natural and there is no disharmony in the face.  You are correct that restoring facial volume with fat grafting is a critical part of facial rejuvenation.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Facelift Sutures

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The last question is the most important-  I think that you need to be able to see if a patient looks natural and not too pulled, yet more youthful, after a facelift to decide if it was performed well.  Subtle things to look for include normal earlobes, natural appearing hairlines, and smooth facial contours.  For the SMAS, I personally use non-absorbable sutures, as they seem in my hands to provide the longest lasting results.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

A Well Done Facelift

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The key element in determining whether a facelift is well done is how well it looks long term and whether the results look natural and non-operated. If one understands the aging facelift you should consider a “Lift & Fill” facelift. You are “lifting” the deep layers with the SMAS and “filling” with those deep layers in the fat compartments. That is the optimal procedure for this to be done in my opinion.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Facelift sutures and addressing volume loss

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I tend to prefer permanent sutures to position the SMAS layer in its new location, though many surgeons use absorbable sutures and get good results as well. You're right that volume loss often needs to be addressed. This can be done at the same time using fat grafting. I find this is more powerful than using SMAS grafts only.

The true test of a well done surgery is the end result. Does is look natural, rather than overdone? Addressing volume loss appropriately is key in this regard, in my opinion. Another factor to keep in mind is the durability of the result. Some quick fix techniques can lead to good short term results that don't provide the long term results most people are looking for.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 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.