I am often asked if I use dissolving sutures during my facelifts or eyelid surgeries (blepharoplasties). The answer is yes and no. I do use dissolving sutures on the inside but never on the outside portion of the skin and for good reason. In short, I do not use dissolving sutures on the outside portion of the skin because I place the highest emphasis on imperceptible to invisible scars, and using dissolvable sutures on the outside does not meet this requirement. To understand why a little bit of knowledge about dissolvable sutures is helpful.
The term “dissolvable suture” is really incorrect. Sutures do not spontaneously dissolve; it’s true they do not. The body actually has to create an inflammatory process to “breakdown” or metabolize or hydrolyze the sutures. Some sutures are designed to create a rapid inflammatory process to quickly breakdown or “dissolve” the sutures whereas others are designed to take weeks to months. The sutures that take weeks to months to “dissolve” are commonly used on the inside or underneath the skin, and I commonly use this type and, of course, these sutures never need removing.
However, on the outside of the skin (where a scar can be visible) the inflammatory process that is required to “dissolve” a suture can cause unsightly scars. That is, the inflammatory process can cause injury to the pigment producing skin cells around the suture, thereby causing white marks or scars that run perpendicular to the scar, which are nearly impossible to correct. This may not happen in most patients but it can in some and it’s hard to predict, so I decided long ago it was not worth the risk for any of my patients.
So knowing this risk why would anyone use dissolvable stitches? The reasons are many but often the surgeon may not have the staff or desire to take the time to remove the sutures, or the patient may be apprehensive about the intermittent, mild discomfort that removing some sutures may cause. However, in my experience, and given the choice, most patients opt for a suture that needs removing, and therein a better, imperceptible scar.
Although there are other factors involved in creating imperceptible to invisible scars, the choice of suture is clearly one that should be considered during any facelift or eyelid surgery.
Timothy R. Miller, M.D.
