Sutures for Lower Facelift and Neck Lift

The term "rolling" suture is probably a reference to a running suture as opposed to an individual or interrupted suture.  In general, the Facelift incision is closed with a series of interrupted and running sutures, employing 5-0 or 6-0 suture material.  With the technique I employ, the suture line is broken up into several components:  the first along the temporal hairline, the second at the junction of the ear (anterior helical crus) to the cheek, the third behind the tragus, the fourth in the perilobular portion of the ear, and so on.  A single running suture can lead to distortion of the natural anatomic components of the ear and is not advised.

While the use of meticulous techniques, fine sutures, and reduced wound tension certainly help in reducing facelift scarring, there are other factors that are important in terms of how a patient scars after a faceclift. Here is what I believe is important to reduce scarring:

 

1. The attention a physician's team pays to wrapping the skin after a facelift can impact scarring. In my opinion, some wrapping techniques place too much pressure on the skin, and such pressure can cause more tissue injury and impact the scars especially in front of the ear.  To this end, it is not only important that you get wrapped correctly after the lift to minimize the pressure, but also that your health care team teaches you and your family good wrapping techniques for your home care.

 

2, Proper wound care on the incison is very important for later scarring results. Patients who are taught to clean the wound well and apply proper wound care medications often get the best scars. Patients who neglect the wound and do nothing in the first 5-7 days can get sub-optimal scarring.

 

3, The use of scar creams is very important to getting an optimal scar line. Physician experience with these products and the proper use of them can be critical for optimal scarring.

 

4. Scar clinic resources are finally important when and if the scar is not optimal. Physicians with access to technologies like lasers can often quickly treat scars, whereas less optimally supplied clinics may not give you access to these technologies. Make sure you ask the physician what resources are immediately available to him or her should your scarring not be optimal.

 

Good luck! Hope this helps.

Short answer - the surgeon is most important, the technique second and third the suture material a distant third. Having practiced the art o plastic surgery for more than two decades (OK almost three) I have had the opportunity to watch surgical greats work during my training and as a professor of plastic surgery as well as critically examine my own results using different sutures, and techniques. The bottom line is that "great surgeons get great results" . For example using a permanent vs a rapid resorption suture (opposite ends of the spectrum) has not made a difference in my patients other than they no longer have to go through the hassle of  suture removal.

Hi BrookeinCO-

I believe the surgeon is referring to a running suture used to close the skin, which is like sewing a hemline. The suture should be fine and is an accepted technique. If you have any questions review the surgeon's before and after photos.

Sincerely

Tom Kaniff

The most important part of the facelift is how the muscles are tightened under the skin, where the incisions are placed and how the skin is re-draped. I use small 5-0 and 6-0 nylon suture to close the top of the skin,  These sutures are on top of several buried absorbable sutures which remove the tension.  The nylon sutures are removed in several days.  Good luck with your surgery.

This is a very common question, however it's not very critical for plastic surgery face lift results.

The plastic surgeon performing your face lift and neck lift will place the appropriate number of stitches. There isn't a magical or normal number, suture material, or length of incision. The longer or bigger the incision, then the more stitches will be required. Some face lift surgeons prefer absorbable stitches, some prefer permanent, while others use both types. Plastic surgeons generally don't count the number of stitches either, as it is not really a factor for face lift surgery. The SMAS treatment under skin is more important.

Speak about these issues with your cosmetic surgeon to help alleviate your concerns.

There are many different types of facelift.  The work done under the skin is more importnat than the scar closure.  However closure of the incision is also important.  I am not sure what your surgeon is doing but I typically use a fine non-absorbable suture that is removed on day 5 or 6.

It makes no difference in the end results. What does make a difference is the type of closure below the skin before the skin stitches go in. That is why I have used permanent nylon sutures under the skin for 35 years!

The sutures used to close a face lift are overrated assuming they are at least a 5-0 or higher.  Otherwise it does not matter where they are placed, how many or in how many layers.  This is based on personal experience and over 100 face lifts.  Make sure your surgeon is certified by the American Board of Plastic Surgery.

Samer W. Cabbabe, M.D.

Board - Certified Plastic Surgeon

Saint Louis Plastic Surgery Consultants

Rolling sutures is typically not the way we perform the facelift. The sutures used during a facelift are very small sutures consisting of 5-0 and 6-0 nylon placed in very inconspicuous areas around, in front, and behind the ears. The other two important areas with regard to scarring are the amount of tension placed on the skin. The more tension that is placed on the skin from pulling will result in wide scars. Having the sutures removed quite early in the process such as day #4 is important to prevent any railroad tracking on the incision itself.