Facial Suture Selection After Facelift
For facial skin closure after facelift surgery, use 5-0 or 6-0 absorbable monofilament sutures (poliglecaprone-25 or polyglactin 910) placed as continuous subcuticular sutures, which provide equivalent cosmetic outcomes to nonabsorbable sutures while eliminating the need for suture removal.
Suture Material and Size
Absorbable vs. Nonabsorbable Sutures
Absorbable sutures (5-0 or 6-0) demonstrate equivalent aesthetic and clinical outcomes compared to nonabsorbable sutures for facial skin closure, with no statistically significant differences in cosmesis scales, infections, wound dehiscence, or scarring 1.
5-0 poliglecaprone-25 provides cosmetically identical results to 6-0 polypropylene in facial closures, with 85% of cases showing no difference between the two materials at 4-month follow-up 2.
5-0 coated polyglactin 910 (Vicryl Rapide) produces equivalent long-term cosmetic results to 5-0 polypropylene in facial wound closures, with no difference in scar formation at 6-month follow-up 3.
Recommended Suture Specifications
Primary choice: 5-0 poliglecaprone-25 or 5-0 polyglactin 910 for superficial facial closure 2, 3.
Alternative sizing: 6-0 polypropylene or 6-0 absorbable sutures can be used for very fine approximation, though 5-0 absorbable provides comparable results 2.
These absorbable sutures retain 50-75% of their original tensile strength after 1 week, providing adequate wound support during the critical healing phase 4.
Suture Technique
Continuous vs. Interrupted Sutures
Continuous subcuticular sutures significantly reduce superficial wound dehiscence (RR 0.08; 95% CI 0.02 to 0.35) compared to interrupted transcutaneous sutures 4.
No difference exists in surgical site infection rates or hospital stay length between continuous and interrupted techniques 4.
The continuous technique provides better wound edge sealing to prevent exogenous bacterial invasion while maintaining adequate perfusion when not overtightened 4.
Layered Closure Approach
Deep dermal layer: 4-0 or 5-0 poliglecaprone-25 for subcutaneous tissue approximation 3.
Superficial layer: 5-0 poliglecaprone-25 or polyglactin 910 as continuous subcuticular suture using the remaining absorbable suture from deep closure 2, 3.
This approach is cost-effective as it eliminates the need for separate nonabsorbable suture material and subsequent removal 2, 3.
Clinical Advantages of Absorbable Sutures
Elimination of suture removal saves surgeon time and reduces patient anxiety and discomfort 3.
No wound complications (infection, hematoma, dehiscence) were observed with absorbable sutures in facial closures 2, 3.
Comparable ease of handling to nonabsorbable materials when using modern monofilament absorbable sutures 2, 3.
Common Pitfalls to Avoid
Avoid overtightening continuous sutures, as this can strangulate wound edges and compromise perfusion 4.
Do not add adhesive strips (steri-strips) routinely, as they provide no additional benefit in reducing scar width or improving cosmetic outcomes when proper subcuticular sutures are used 4.
Tissue adhesives alone are inferior to sutures, with significantly higher wound dehiscence rates (RR 3.35; 95% CI 1.53 to 7.33) 4.