Complications of facial suspension sutures

Background: Barbed suture suspension has gained popularity as an inexpensive, "non-surgical" facial rejuvenation procedure. Initial studies on this procedure have reported minimal complications. Objective: In this article, we review and evaluate several cases involving complications resulting from barbed suture suspension. Methods: Four case histories of patients who required removal of suspension sutures because of symptomatic suture, failure, settling, or infection are summarized. The suspension sutures involved were examined after removal and compared to suture withdrawn through bovine muscle. Results: Two patients reported chronic foreign body sensation. One patient had facial weakness. One patient had obvious dimpling. One patient had localized infection resulting from suture placement. On removal, the barbs on the suspension sutures appeared to be reflected against the direction of lift. Additionally, some sutures were clearly mobile. Forced withdrawal of new suture through bovine muscle did not result in similar anteversion of suture barbs. This would suggest the barb orientation noted at surgery was not the result of the removal process. Identification can be difficult, as the suture in some cases is clear. Once the sutures had been identified, they were easily pulled out without the need for additional surgical access. Conclusions: 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.