Facelift with or without permanent suture?

If you feel that your face does not reflect how young you feel on the inside, a facelift may be the solution to help you look and feel younger. During your consultation, your doctor will evaluate your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure. Based on this evaluation, he/she will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. Your doctor should make sure you have a full understanding of what results to expect.Always insist on a board certified surgeon!
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Good question. I understand the concern over your auto immune disease and surgery but a suture whether it is non absorbable of absorbable will likely not likely aggravate your disease or cause an issue with your result.  I would more likely focus on the doctor's experience and overall results and how you two connect over sutures.  If you really do not want permanent sutures in the muscle layer I am sure he could modify the technique but again it probably will not matter.  At times permanent sutures do cause a reaction called a suture granuloma.  I think this is about 1 in 300 and can happen regardless of auto immune disease or not.  When this happens the suture is easily removed without much consequence.  

Both permanent and dissolvable sutures are used depending on each surgeon's preferences.  These sutures should not cause a reaction because of your autoimmune condition.  Most importantly is that you are not taking steroids or other medications that would impair your normal wound healing.  

I have performed well over 3,000 facelifts. Initially for the first 500 of my facelifts, I used non-absorbable sutures using my Double C plication technique.  About 4% of my patients had sutures reaction and extrusions. After that I changed my sutures to Vicryl, which absorbs in 6 months. I have noticed no difference in the long-term outcomes. Once the SMAS that is tightened with Vicryl is healed, in a few months, the facelift results will not be affected. I have published my Double C plication technique that describes the rotational angles and amount of tension that must be applied during SMAS plication to avoid over or under tightening. Using my technique, I apply gradual tension on my SMAS as follow: starting at temple area there is only 20-30% tension on muscle plication, once at the jawlines the muscle is tightened 100%. This prevent pulled looked at the corner of mouth. In neck area the muscle must be tighten with greater tension than 100%, depending on the neck laxity.  The absorbable sutures are not contraindication to autoimmune diseases. 

The surgical procedure can be performed with long acting temporary sutures or permanent sutures.  Ultimately the outcome of the surgery relies on the surgical technique and the repositioning of deeper layers of the face and  skin than the type of sutures used.  

I appreciate your question and I understand your concerns. In most cases, permanent sutures do not aggravate autoimmune disorders. These types of sutures are frequently used in facelift procedures, although they are not the only technique available to plastic surgeons today. I would advise you to seek a second opinion from another plastic surgeon in person if you are not comfortable with the recommendation of your first doctor. It is critical that you are comfortable both with the surgeon and the procedure that will be performed prior to scheduling your surgery. Best wishes for a safe and successful facelift procedure!

Thank you for your question. The use of non-dissolvable sutures is a widespread practice and the polyester or nylon material does not seem to inflame autoimmune conditions. Have you discussed your concerns with your surgeon? Are they aware of any reactions you’ve had to synthetic materials before? Do they know what medications you take that might cause complications? It is extremely important that you choose a specialist plastic surgeon that you are comfortable with and that you are thorough and honest in explaining your medical history and any concerns you might have. If this is something you think will be a constant worry for you after your procedure, it might be a better option to wait until you can find a surgeon with a technique that you’re more comfortable with. Good luck!

Hi  Antonella,  First off the type of suture used will mos likely cause no issues with you autoimmune disease.  That said there is also probably very little difference in the longevity of a facelift based on the type of suture.  Sutures are used to hold up the SMAS layer in the cheek and to tighten the muscles in the neck. The tissues are most likely healed in place before the sutures dissolve but no one really knows. I use permanent sutures because if there is a difference in the longevity and no negatives to permanent sutures then why not.  Even using them however the tissues will continue to age and fall and that is why nothing is permanent and sutures don't guarantee results.  Good technique gives the best results

In our practice for over 25 years, we have used permanent nylon sutures to hold the SMAS and muscle layers together in the face and neck.  Nylon sutures are inert and rarely ever cause  an issue

The only "permanent suture" in facelift surgery is the normal scar formation that your body produces as it heals. The goal is to hold the tissues in place until that happens. Once accomplished, there is no need for a suture to remain. There are sutures that last for from four to nine months that are commonly used which accomplish that goal. While most permanent sutures do not give any problems, some can extrude or migrate in time so I no longer use them. Long term results depend on having good genetics, a healthy lifestyle, limited sun exposure, lack of smoking, and regular exercise. John Standefer MD