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The complications of tracheotomy are routinely categorized from the time of operation to the onset of the complication and are thus divided into intraoperative, early, and late postoperative. A very common late complication is the development of granulation tissue. We describe a case of granulation tissue that formed around a retained silk suture obscuring about 40% of the lumen at exhalation and about 80% of the lumen with inspiration. The patient clinically experienced stridor, poor exercise tolerance, and difficulty in clearing tracheobronchial secretions. As a result, the patient required CO2 laser excision of the suture granuloma using a rigid ventilating bronchoscope and removal of the suture. We present an unusual but serious case of progressive airway obstruction.