Sutures, stitches and staples for lower Facelift?

Question

Which approach has the best results ( better looking scars, faster healing, adds time to the surgery)?

Thomas P. Sterry, MD · Answer

You are asking one of the Million Dollar Questions in Plastic Surgery.Personally, I use a combination of dissolvable sutures, permanent sutures (which need to be removed), and sometimes staples IF the scar is inside the hairline.The dissolvable sutures are used deep inside the cheek in order to hold the tissues where I want them to stay.  They typically stay in place for about 3-4 months before being absorbed.I like to use permanent monofiliament sutures (like nylon or praline) in the skin to approximate the wound edges because your body is unlikely to react to them as long as they are removed by day 5 or so.Staples are occasionally useful within the hairline because they are a very fast way to close the scar that nobody is ever going to see anyway.  Furthermore, I remove them at day 5 as well (when I take out the sutures) so there shouldn't be any visible "railroad track" marks from them.  The reason time is important is that the Anesthesia is so expensive.  If I can save the patient 20 minutes of OR time by using staples and nobody is going to know the difference two weeks later, then that equates to real dollars and cents.Okay, sorry for the long answer, but that's what I use and why I use them...Good Luck!

Mark Karolak, DO, FAOCO · Answer

After having performed thousands of face and neck lifts
comfortably under local anesthesia, I have found that, in my hands, an incision
most consistently heals as a thin line with gentle handling of the skin edges,
minimal tension on the incision line (not pulling the skin too tight),
 and the use of fine sutures.  Although it is quicker to use staples,
I personally prefer the control I have over each stitch placement to align the
skin edges for the most pleasing result that I can achieve. Healing times are
relatively similar for both.

Dilip D. Madnani, MD, FACS · Answer

This is really a question that depends on surgeon preference. You can read below, but every surgeon will have his/her own preference for closure of the surgery. It It really doesn't matter what the surgeon uses to close, look at the surgeons beofres and afters and have a frank discussion with them about what you can realistically expect for scars. The  incisions are placed in natural lines of the ears so scarring should be imperceptible. I do my procedures without general anesthesia, I find it helps with a quicker recovery. I also remove all my sutures at 1 week and do not sure staples. Thats my preference. Good luck!

Raymond E. Lee, MD · Answer

Thanks for sharing.  For a lower facelift and necklift i use fine sutures to close the wound. Staples are usually used to close incisions in the scalp such as a browlift incision.  I use some absorbing and some non absorbing sutures. I close the skin in two laser to decrease wound tension and get the best result.  Many things come into play when achieving the best results.  Experience matters so select a board certified facelift facial plastic surgeon who has performed many facelifts.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi.  It depends exactly where your scar is going to be placed.  If the scar is completely within the hairline then there is an advantage to staples as they are not circumferential and therefore cause less trauma to the hair follicles.  I make my incision just inside the temporal hairline and prefer to use sutures in this circumstances.  it is important that there is minimal tension on the skin at the end and this is done by suspending the SMAS layer.  Regards

Mark T. Boschert, MD · Answer

The method of closure is based upon the area which is being closed. Staples in my opinion are only okay if they are within the hair bearing areas of the scalp. After that fine sutures around the ear are permanent ones which were removed at about 5-7 days. Any sutures in this area will do very well, I like the removal ones because I believe it causes less irritation and finer scars in the long run.Good luck!

Charles A. Wallace, MD · Answer

I use internal dissolvable sutures (stitches) which give a nice closureto the areas, allowing the edges of the skin to heal smoothly.

Patrick J. Byrne, MD, FACS · Answer

I use sutures. I believe it provides the most control over the skin edges to ensure the best possible healing.

William Portuese, MD · Answer

In our practice, we use dissolvable sutures behind the ear,  permanent stitches to hold the facial and neck muscles tight, regular sutures in front and behind the ears and  A few staples in the hairline. More important than what is used to close the incision is: when the  sutures are removed to prevent crosshatching  and how much tension is put on the incision.

Robert E. Zaworski, MD (retired) · Answer

Closure of facelift incisions depends on surgeon preference.  I use sutures for the best possible healing.

Sutures, stitches and staples for lower Facelift?

Answers (11)

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