Abstract
BACKGROUND: Absorbable barbed sutures have been widely used for minimally invasive facial rejuvenation. However, clinical lifting performance varies due to differences in suture geometry, which remain insufficiently quantified. OBJECTIVE: The study aims to evaluate the effects of barb rotation angle, barb orientation, and pulling speed on the lifting performance and efficiency of the barbed sutures. The goal is to identify the optimized geometric design for facial lifting applications. METHODS: The barbs were fabricated with four rotation angles (30°, 45°, 90°, and 180°) and four orientations (Forward, Reverse, Forward-Reverse, and Reverse-Forward). The fabricated sutures were tested at 10, 50, and 100 mm/min. Maximum lifting and holding displacements and lifting efficiency were quantified. Statistical analysis was conducted using one-way ANOVA with Tukey's post hoc test (p < 0.05). RESULTS: Higher pulling speed increased maximum lift but reduced efficiency due to slippage. The maximum lift was at 100 mm/min (2.03 ± 0.08 mm), whereas the highest lifting efficiency was at 10 mm/min (42.7%). For the barb rotation angles, the 90° configuration showed the highest lifting efficiency (35.5%) and superior anchor stability (p < 0.05). Regarding the barb orientation, the Forward orientation produced the largest lift (1.72 ± 0.18 mm), while the Forward-Reverse orientation achieved the highest efficiency (35.5%). The optimized Forward-Reverse 90° configuration exhibited improved holding capacity and reduced slippage compared to a commercial barbed suture. CONCLUSION: Barb geometry critically affects the lifting performance of the suture. The Forward-Reverse 90° configuration shows the optimal lifting efficiency and stability, offering clinically relevant guidance for designing next-generation facial lifting sutures.