Protruding Suture After Facelift Stuck on Something?

A suture from a previous Facelift that's just under the surface about two inches below and behind my ear poking out. The plastic surgeon in Costa Rica told me to have it removed. The primary care physician here tried to remove it, but it seems to be "stuck" on something. He got some to come out, but when he tugs, it seems to be a couple of inches lower than the part he can access. He sees it pulling beneath the skin forward toward my chin just under the jawline directly below my earlobe. It now feels swollen and sore.

What is this? Is this suture holding anything? What could be keeping it from coming out? Will I have problems with something "falling" if I have it removed? Any idea why it won't come out when the doctor tried to gently pull it out?

Doctor Answers 9

Protruding Sutures Should be Removed

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I would remove any protruding sutures from a facelift in the past. Go to a board certified plastic surgeon. He/She will be able to remove it. 

Protruding Suture Facelift

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Sutures can protrude after a facelift.  Permanent sutures placed deep under the skin have a much higher chance of protruding and can lead to infections.  These sutures need to be removed in all instances.  My opinion is that there is not a real role for permanent suture placement in the deep tissues.  If the face has been lifted and repositioned properly, it will heal in a new location.  A permanent suture is a foreign body which some patients can reject.

Dissolving sutures are much less likely to resurface on the skin.  These can be melted with a variety of techniques or removed.  The threshold to remove a dissolving suture is much less.

Barbed sutures, such as those seen in a thread lift, are much more difficult to remove.   Most of the time, removing these sutures requires a slightly larger incision, due to the nature of the design of these sutures.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 172 reviews

Unwanted Stitch

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First, you should contact the surgeon in Costa Rica to get a copy of the operative report. With that in hand, see an experienced facelift surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 42 reviews

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See a facelift specialist

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It sounds like you have a deep suture causing problems. It is best to see a facelift specialist for evaluation and possible removal of the suture. There are many possibilities about what is going on with the suture and a specialist would have the best idea on how to proceed. Good luck.

The Face Lift suture should be evaluated and removed by a specialist.

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You should consult a board-certified plastic or facial plastic surgeon that performs this operation regularly.

Permanent sutures may extrude, and removing them more than 6 mos following face lift does not usually affect your appearance.

Tenderness could mean infection, so you should have this looked at by a qualified specialist as soon as possible.

Best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 432 reviews

Get to a local plastic surgeon

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There are immediate concerns and long term concerns here. The pain and swelling you have may simply be local irritation from the attempt at removing the suture. However, there is the possibility that the area may have been contaminated by the failed attempt at removing the suture and you may now have a cellulitis or local infection which will require treatment.

A local plastic surgeon will be able to help with both the suture removal and the treatment of the area at this time.

The suture is most likely a permanent suture and it sounds as if it is supporting the tissue of the neck and jawline. The suture may also be barbed which would make it more difficult to remove. If it is supportive you may lose some of the correction achieveed with the facelift. At this point there is no alternative. I do not believe the suture can be salvaged.

A plastic surgeon in your area will be able to help you with each of these issues resolving the short term problem and preparing you for the possibility of a future correction.

I would not delay on getting this resolved. Good luck.

Robert W. Kessler, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 130 reviews

Complications after surgery abroad

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Unfortunately the only person who really knows what that suture is attached to is the surgeon who put it there in the first place. It is probably some sort of a suspension suture which was used to elevate the tissues in your neck, under your chin. Sometimes these sutures are barbed, rendering them extremely difficult to pull out. Attempting to pull out a barbed suture can leave broken pieces of suture and barbs embedded in your tissues. Even if the suture is smooth, it may be sewn into your neck muscles or attached to another suture deeper under your chin. Your best bet would be to fly back to Costa Rica and have the operating surgeon fix the problem. I recommend treating the complication soon, since you are experiencing pain and tenderness in the area.

Pamela B. Rosen, MD
Coral Springs Plastic Surgeon

Your best bet is with your original doctor or at least a facelift specialist

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There are a number of things that need to be considered before removing this suture. First, how long has it been since surgery? Is it a dissolvable suture or a permanent suture? Third, is it a suspension suture or is the knot right over the area that it is holding?

You might contact your original surgeon with these questions so it will make it easier for a local expert to more sucessfully treat this protruding suture.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 136 reviews

Facelift suture coming out

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If the suture is protruding through the skin it should be removed since it could become infected. If a barbed suture was used that could account for the tugging further out on the skin. In any case, any facial plastic surgeon would be able to remove this.

Marcelo Hochman, MD
Charleston Facial Plastic Surgeon

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.