Complications of facial suspension sutures

Abstract

Suture suspension may gradually fail due to eversion of suture barbs or migration through tissues. Although the complication rate for this technique has been reported to be low, we believe that surgeons performing this procedure should be aware the rate may be higher than indicated in the literature.

Barbed sutures “lunch time” lifting: evidence‐based efficacy

“…They are available also as long Woffles threads (Kolster Methods Inc., Corona, CA, USA) 5,32 that can be introduced into the sagging tissues of the face then doubled to form a sling suspending the sagging tissues of the face to the stable temporal scalp through which the suture ends emerge 5,32 . Contour Threads, patented under the name Featherlift Extended Aptos Length Threads, 6 also referred to as Thread Lift or Loop Lift (with a looped suture) (Surgical Specialties Corp., Reading, PA, USA) 6,43 are unidirectional and their deployment is fundamentally different from the classical Aptos threads 40 . They are designed to “bunch up” the tissues and be anchored to a fixed structure, such as the deep temporal fascia 40 .…”

“…The double‐convergence polypropylene monofilament threads have been tested in Brazil (known as Beramendi threads) 18 . These threads do not have approval from the Food and Drug Administration at this time 43 . In general, Permanent barbed sutures are approved for correcting facial and cervical ptosis and for approximating wounds in soft tissue 42 .…”

“…Even when techniques were modified to ‘‘catch’’ some of the fascia overlying the platysma muscle, results on the neck continued to be inferior to those seen in the malar region 4 . Barbed sutures seem to provide little traction on tissue after 1 month of healing, especially in dynamic areas such as the forehead 43 …”

The Application of Barbed Sutures in Body Contouring Surgery

“…15 Extrusion, infection, and palpability have all been reported complications in the literature. 13,16 Long-term clinical outcomes have not proven to meet the theoretic advantages of barbed sutures in the face, and concerns about underreporting of actual complication rates have been raised, particularly with regard to potential suture breakage with dynamic facial movement and failure of the barbs from tension. 13,16 Barbed suture technology in face and neck rejuvenation has remained a niche treatment, and use of these sutures is currently "off-label" for this type of surgery.…”

“…Barbed sutures originally gained popularity in minimally invasive facelifting but have demonstrated questionable results in maintaining a stable, remarkable outcome. [13][14][15][16] The facelift barbed suture, applied with the use of a trochar, is primarily a 2-0 polypropylene, permanent suture and may have uni-or bidirectional barbs. The primary mechanism of action of these sutures in the face is purchase of the barbs opposite to the direction of pull, anchoring the tissues and maintaining suspension.…”