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How Common is It for a Suture Line to Rupture After a Tummy Tuck vs Facelift? (graphic photo)

This is after a face lift. The "stitches" had been removed and I felt something sticking out above the stitchline and gave it a little tug. Needless to say, ALL the stitches had not been removed and what followed my tug would make anyone scared to do anything like this again. I have been told that a tummy tuck is not as difficult as a facelift. How common is it for suture lines to rupture or get infected?

Update: My facelift was almost one year ago and it did heal nicely for the amount that it ruptured. Just so you know, I was a part time (6 months of the year) smoker 27 yrs ago. I quit when I got pregnant with my first child. I am not diabetic but do have post polio syndrome and other issues. My question was due to concern about an up coming tummy tuck and the likely hood that it would also rupture. I talked to my surgeon today and feel confident that thing will be just fine. Thanks for all of the feedback. It gave me the impetus to go talk with my Doctor AGAIN just to make sure all is OK.

Doctor Answers (10)

Facelift suture line problem is not rupture.

+2

Your problem is inadequate blood flow leading to incomplete healing and partial thickness skin loss in the narrow flap behind your ear. This can be a result of natrually poor circulation (such as in diabetics), or in vasoconstricted circulation (such as in smokers, nicotine users, or those exposed to second-hand smoke).

Unfortunately, it can also occur in patients who have normal circulation and do not smoke or use nicotine--it's more rare, but can occur. I agree with my colleagues that this will heal remarkably better than it looks it could ever be right now. Careful follow-up and wound care is critical to minimize further tissue loss and maximize healing.

Just for those patients that might be wondering if this common: this is extremely unusual, but this patient's problem is partially a result of the incision design. The post-auricular (behind the ear) incision goes high behind the ear, but instead of crossing into the scalp at this high point, the surgeon chose to create a long, narrow skin flap by bringing the incision down along the hairline. (The discussion about the pros and cons of this choice are outside the scope of this answer, but relate to avoiding a "notch" in the hairline.)

Back to basic plastic surgery--a long narrow skin flap undergoes inevitable necrosis (skin death) at the tip of the flap because of inadequate blood flow to this area. Even in facial skin, where the circulation is unusually robust, the behind-the-ear skin is furthest from oxygenated arterial feeder vessels, and creating a too-narrow and too-long flap increases the risk that this can occur. Even if this incision design is chosen repeatedly without apparent problem, in certain patients, perhaps ones with just a tiny bit less blood flow, lower blood pressure, or an otherwise minor skin bacteria contamination, dead skin can occur, and the suture line breaks down, as it did in this patient.

Tummy tucks involve lifting large skin flaps as well, but ones that are hip-to-hip wide, so the blood flow to the "tip of the flap" is correspondingly greater. But, excessive tension, bleeding, superficial infection, smoking, diabetes, etc. can cause the same skin necrosis problems in the abdominal skin most distant from the blood supply (just above the pubic incision in the center) or where the blood supply is narrow and constricted (the umbilical stalk).

Neither operation is "difficult" for experienced and fully-trained ABPS-certified plastic surgeons, but both require attention to detail, proper adherence to basic plastic surgical principles, and careful incision placement. But this could happen to any of us, or any of our patients. BTW, it wasn't your fault that you gave a little tug. This would have happened anyway. Hang in there. Best wishes!


Minneapolis Plastic Surgeon
5.0 out of 5 stars 144 reviews

Suture Line Rupture vs Skin Necrosis

+1

   A suture line rupture in a healthy person can happen but this does not happen very often.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

How Common is It for a Suture Line to Rupture After a Tummy Tuck vs Facelift?

+1

  This shows a skin necrosis of the face lift flap along it's most vunerable section just behind the ear.  This can result from an extensive surgery and skin flap elevation, poor circulation or post op infection.  Unless there's a medical history that includes decreased circulation, this is and could very well be an isolated issue with your Face Lift.  It should, IMHO, at the very least make you much more cautious about your activiyty level the first month following your Tummy Tuck to avoid a similar issue.  It's good to have this conversation with your plastic and cosmetic surgeon so he/she can advise you on what constitutes limited activity following your Abdominoplasty.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

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Post auricular disruption

+1

This will heal over time inconspicuously. It appears you are or have been a smoker or have other issues with circulation.

Richard Ellenbogen, MD
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Post - Auricular Facelift Wound Necrosis

+1

Hi,

This is as a skin necrosis of the post-auricular incision most probably due to poor blood supply to the distal skin flap. This part of the  facelift incision is under the most tension and is very susceptible to poor circulation. If you are a smoker or have any medical issues such as diabetes this can increase your risk for poor wound healing and necrosis. This will probably heal with good wound care over several weeks. I also think the cosmetic result will not be as bad as it looks now. I'm sure your surgeon will help you through this.

Best,

Dr.S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
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Agree with the other posters here. This is not a wound dehiscence.

+1

This is classic skin necrosis after a facelift.  It looks ugly today and it will heal with some scaring but it is remarkable how acceptable this type of area heals.  I would recommend close follow up with your surgeon.  Do not get discouraged.  What happened here is what often happens when smokers, or former smokers have a facelift.  This is also seen when diabetics have facelifts.  For this reason, I generally will not perform facelifts on individuals who have smoked or who are diabetic.  However, other surgeons will and spend time preparing there patient for this type of expected post operative issue.  As I have said while this looks ugly and it will heal with scar tissue, a year from now this may appear very quiet and give very little indication of the trouble you went through to heal.  Which is more likely to rupture after surgery?: A tummy tuck by far as there is much more tension on the abdominal wall wound.   Hang in there.  With the guidance of your surgeon this will heal.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
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SUTURE LINE RUPTURE

+1

I agree with previous posts. There are a number of factors that increase your chance of this happening. Among the most common, and the ones where something could be done after the fact are: smoking, or tobacco use in any form (gum included), previous long term use of steroids. If any of these apply, stopping or decreasing its use would help.

My Best,

Michel Siegel, MD
Houston Facial Plastic Surgeon
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Wound healing issue

+1

Judging by the photos I would say that the problem has to do with wound healing and blood supply rather than simply the stitches.  To answer your question, it is not very common in any case for a sutured wound after any operation to open.  Usually this is the end result of another primary problem.

In your case you should follow up closely with you plastic surgeon.

Thank you for the question and for the photo.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
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Wound healing issues behind ear

+1

The area of concern is most likely the result of poor healing from reduced blood supply.  You should follow up with your surgeon.

Sam Naficy, MD
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Rupture of a suture line after a facelift or tummy suck

+1

The photos is not a rupture of the suture line. It is a result of loss skin from of blood supply deficit. This can happen, particularly in smokers, but it can happen in anyone. Excess tension on the flap can also cause this problem along with a hematoma (blood under the flap) or an infection. This patient should be place in the hyperbaric oxygen chamber. Antibiotics should be used along with topical muperocin (a very effective antibiotic ointment). When all is said and done, the scar may be less than you can imagine, but this will take many weeks to finally close and at least a year to see the final result.

Any procedure can do the same, particularly when a flap is concerned, such as a tummy tuck. The best you can do is limit bleeding by taking no aspirin, advil, motrin, fish oil, Vitamin E, flax seed oil or any thing else that can increase your bleeding time for two weeks. Eat healthily and follow your doctors advice at all times.

E. Ronald Finger, MD
Savannah Plastic Surgeon
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.