SMAS Mid Face Lift Support Suture Cut but Left in Face (photo)

2 months ago I had a SMAS mid face lift. In addition I paid for a support suture that extended in a triangle from my temple to the cheek and right above my ear. Per Dr, more of the cheek muscle was grabbed on the left Vs. right side leaving my face noticeably assymetrical. Dr. tried pulling on my face 4 times to loosen the suture. The pulling did not improve symmetry, so he cut the supporting suture but left the suture in. Is there a risk to leaving the suture in? Please help!

Doctor Answers 10

SMAS Mid Face Lift Support Suture Cut but Left in Face

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Dear NGA,

Thank you for your post.  The suture in you face has the same risk of infection if it is holding tissue or just laying there.  If this suture gets infected, then it needs to be removed.

best wishes,

Pablo Prichard, MD

Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

SMAS Mid Face Lift Support Suture Cut but Left in Face

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Leaving a suture in the tissue in MOST cases does not cause any issues. But ONLY IN PERSON examination could allow a more definitive response. 

Asymmetry after a face lift

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Generally speaking, there is no significant risk to leaving a permanent suture in place.  There is always a small risk that it could become infected, but this is slight.


Hopefully with time, as the swelling resolves, symmetry and appearance will continue to improve.


SMAS Facelift

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To answer the question one needs to read the operative note and see what was really done during the procedure.

If the Dr. performed a SMAS facelift, then there is no need for the "supporting suture" This supporting suture ia quess is a barbed suture (Did not work in the past and will not work now). Now repairing the significant remaining asymmetry need correction. This may need reoperating, try to undo what was done, if possible, and do a proper SMAS facelift. You need a consultation and review of records by a Board Certified Plastic Surgeon, and possibly be prepared for Facelift, fat grafts. At 8 weeks post surgery, the scars inside has formed and reversal is not easy, then the surgeon needs to correct as he/she sees appropriate during surgery. The presence of the surture, and not removing it depend on the type of suture.

Samir Shureih, MD
Baltimore Plastic Surgeon

Supporting suture in face lift

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Leaving a permanent suture in place is not a problem. Some use permanent sutures on the SMAS.  If you need a revision, best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

No definite / high risk in leaving suture

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Hi, I am sorry to hear about this difficult problem. Sutures can be left in the face and not cause any problems usually, but there is always a slight possibility of suture infection or extrusion. If the suture is resorbable, it will go away in time. Signs of infection are redness, fever >101.5, and purulent drainage from a wound. At this point, you do have noticeable assymmetry and will likely benefit from revision facelift surgery in the near future. You should see your plastic surgeon to discuss this problem further.

Jeremy B. White, MD
Miami Plastic Surgeon

SMAS Mid Face Lift Support Suture Cut but Left in Face

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     Leaving a suture in the face may not have any impact at all.  I personally do not use permanent sutures, but many do.   Kenneth Hughes, MD Los Angeles, CA

SMAS Mid Face Lift Support Suture Cut but Left in Face

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Thank you for your interesting question and the information provided along with the photo.  I find having to additionally "pay for a support suture that extended...." somewhat ridiculous.  Either you misunderstood what your doctor said, or this is an awkward way of charging for this procedure.  No one that I know breaks down payment for the procedure into segments or "sutures" for that matter.  However, if your question is whether it is OK to leave the cut stitch behind, yes it most likely is because that suture would have been left in place anyway, so whether it is tied or cut really does not matter.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Asymmetry should be addressed

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I have removed sutures placed by thread lift technique as your surgeon appears to have completed for you. These sutures are often permanent and do not dissolve. They do not necessarily have to be removed unless you develop a reaction to the suture itself causing a local wound infection. The concern is more the asymmetry that develops from the suture being cut and now not suspending the cheek tissue. As this procedure is becoming more prominent in Asia I have begun seeing these problems occur more often. One alternative to address this asymmetry is the use of fillers, but the best result is in reperforming the original surgery, removing the suspension sutures, and recontouring and suspending the SMAS in the correct trajectory. I would discuss this with your original surgeon or if you don't feel comfortable get several opinions from different qualified surgeons before proceeding further.

Kristina Tansavatdi, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 44 reviews

Asymmetry after Facelift with ? Support Suture

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Hello 'SeekingGoodDoc', thanks for your question.  I am not clear on what technique was used for your facelift procedure.  A review of the operative report would be helpful.  It sounds like they may have used a Quill suture to try to elevate your facial soft tissue.  This is a technique that I, and many of my colleagues, do not use as there is a high risk of asymmetry, puckering, and long-term unreliable results.  Once it is done, options for treating asymmetry include massage, releasing/ removing sutures, or re-operation to fix the deformities.  Hopefully you went to a board-certified plastic surgeon who will be fully trained and adept at handling these postop issues.  Depending on what type of suture was used, the 'supporting suture' may dissolve on its own.  However, even if it is permanent, it may be left alone as long as it does not get infected or lead to persistent deformities of the facial contour.  Hope that helps.


Parviz Goshtasby, MD, FACS
Newport Beach 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.