What is the best suture to use for a longer and better result when it comes to a SMAS Facelift?

Doctor Answers 6

Best sutures for Facelift

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Excelent question. It really does not depend on the sutures itself, but on grade of tension you leave on the skin. In the SMAS Facelift you pull the SMAS and all the muscles and skin in an upward vector and when you do this the excess skin is removed and left in place with the inicial facelift incision. At this point the skin should be completely FREE of any tension. When you suture this tension free skin, it really doesn't matter what suture you use because the results will be excellent and you won't even notice a scar. If you suture the skin and there's any tension on it, it will develop an hypertrophic scar or keloid, regardless of the suture you use. Hope this answers your question.

Colombia Facial Plastic Surgeon

What is the best suture to use for a longer and better result when it comes to a SMAS Facelift?

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Hi, I have performed facelifts for over 30 years.   The key to the very best possible results, IMVHO, is the ability of the Facelift Surgeon to shape the face making it more famine and beautiful or more chiseled and handsome.   I use multiple sizes and types of sutures during our SMAS facelift depending on what tissue layer is being sutured.

 Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. I shape the cheeks, chin and jaw line with every facelift procedure.

 In contrast, men look ruggedly handsome with angularity in the cheeks, chin and mandibular angles. From the photos, your cheeks are flat anteriorly (in the front), the chin is weak as are the mandibular angles and there is excess facial fat in front and below the cheeks. This combines to create an elongated oval shaped face. The following procedures would create a more ruggedly handsome face.

  • Cheek augmentation with cheek implants to add angularity to the cheeks and mid face. This would be combined with liposuction to reduce the excess facial fat to further define the cheek shape.
  • Chin augmentation, using a chin implant, to add projection to the chin creating harmony and balance to the lower face.
  • Augmentation of the mandibular angles using a dermal filler (jaw implants have too many unwanted side effects IMHO) to add volume, angularity and flare to the jaw line.

 If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation. I have performed many Cheek Augmentations over the past 30 years and the notion that Cheek Implants or dermal fillers to the cheeks, by themselves, will lift tissues is an urban myth. Filler to the cheeks or cheek implants will shape the cheeks but alone will not lift up the jowls. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine whatever facial shaping that's necessary with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Sutures used in the facelift procedure

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 In our practice, we use permanent nylon and Mersilene sutures to hold the tissues in place. The type of sutures used  is irrelevant, and the surgical technique of the surgeon is more important to get a natural result.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews


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The type of suture does not play any role in the longevity of the facelift.
It is the knowledge and experience of the surgeon and the proper technic.

Samir Shureih, MD
Baltimore Plastic Surgeon


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good question, but not to worry. technique is everything. the sutures are only in place long enough for the tissues to heal. after that it is up to , time , gravity and genetics. I believe that a better life style, no smoking and exercise with a good diet will prolong your results. so good technique and lifestyle is the winning combination.

Key is planning

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The key to a facelift is planning and execution.
The tissues when released can be repaired with a variety of sutures.
When the tissues are released they are easily sutured.

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.