In 2006 the US National Vital Statistics Report recorded 33,300 suicides in the United States, of which hanging, strangulation and suffocation combined to account for 7,491 (22.5%) of the cases. Self strangulation by ligature is uncommon and in the majority of cases, scarves, belts, neckties and rope are used. We report three instances where cable ties were secured around the neck in order to commit suicide. All had a history of depression. One was a 37-year-old man who used a belt to complete the act after an unsuccessful attempt to use cable ties. The second was a 63-year old woman who used multiple cable ties to accomplish her goal. In the third case a tensioning tool was used by a 54-year old man to tighten a cable tie around his neck during self strangulation. Utilization of a tool to tighten the cable ties has not previously been reported.