The relatively large amount of suture material that is left in situ with this technique means that the chances of foreign-body reaction, suture abscess, or suture spitting are probably higher than with other suspension suture approaches. This should be taken into account before broadly adopting this approach.
Since the anchoring suture is tied directly to the previously placed buried vertical mattress suture, the additional torque placed on the buried suture may translate into a greater risk of suture material rupture, or at least of added tension on the dermis where the buried vertical mattress suture is anchored. Therefore, attention to detail in placing and tying the buried vertical mattress suture is of particular importance when utilizing this technique.
As with any suspension suture, there is a risk of damaging underlying structures when placing the anchoring bite of suture material. Comfort with and knowledge of the underlying anatomy, and particularly the location of neural and vascular bundles, is of paramount importance when adopting this approach.
Finally, there is a risk of creating a longstanding depression at the site of suture placement. While the immediate postoperative dimpling generally resolves, this depends largely on the patient’s fibrotic response, and an exaggerated fibrotic response may translate into a permanent depression at the site of suture placement.