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Can Internal Stitches Work Their Way out After a Face Lift?

I had a face and neck lift 8 weeks ago and have suddenly developed an angry red area immediately in front of the right ear. Can this be from a problem originating underneath the skin which is manifesting itself so late after surgery? there is also a noticeable elongated dent on that side.. Any suggestions as to the cause? I'm getting concerned because of the time elapsed since surgery.

The redness I have developed is not within the scar line in front of the ear but about 1/2 cm further away, it doesn't touch the scar. I'm therefore wondering if the surgeon placed a stitch in that spot to hold up the jowl fat and this is now causing the problem.There is no pain or swelling, just redness.

Doctor Answers (12)

Do I have a suture granuloma?

+3

It's possible that you have a suture granuloma. This occurs when the suture underneath the skin that is anchoring the muscle takes longer than normal to dissolve and for whatever reason, the body mounts an inflammatory response. The result is that the suture can work its way to the surface and create a "spitting" effect when there is a small amount of drainage around the suture. On the rare occasion that this happens to me I will typically put the patient on antibiotics and try kenalog (steroid) injection into the area of inflammation. If this still does not resolve the inflammation the suture may have to be removed. 

Without seeing pictures it is difficult to determine what would be causing an elongated dent on the side of your face. If a drain was placed in that region it can sometimes heal with a ridge however this will usually fix itself within a couple of weeks. There are several other possibilities. I would follow up with your surgeon for further analysis.


Orange County Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Angry red area and elongated dent in front of right ear need to be addressed by your surgeon

+3

The physical findings you describe should be presented to your operating surgeon, as (s)/he is the most qualified to diagnose and treat them.  While redness in the suture line can be expected, it should be symmetric and present on the left side as well.  The technique used for your facelift undoubtedly will "explain" the physical findings.  Please consult with your PS for optimal results.  Good luck.

Lavinia Chong, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 39 reviews

Redness After a Facelift, It Could Be a Suture, But You Need To See Your Doctor

+3

Anytime there is a sudden change after surgery even at 8 weeks out, you doctor needs to be notified.  Symptoms such as redness, warmth, swelling, or a new dent could range from a minor issue to something more serious.  It is very likely that there could be a reaction from an suture underneath the skin, but there are other causes that need to eliminated, infections, skin breakdown, and other rare causes.  In this situation, I would have your doctor see the red area ASAP.  

 

I hope this helps!

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

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Can Stitches Work Their Way Out after Facelift?

+3

It is possible for stitches to work their way out 8 weeks after surgery. On very rare occasions over the last 35 years I've had sutures come to the surface several years after a facelift. The elongated dent may be secondary to unresolved swelling. See your surgeon for possible removal of a stitch and an explanation of your dent.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Please contact your surgeon and have this evaluated.

+3

Burried suture, permanent or absorbable can become inflamed.  The process is call "spitting."  It is the body's way of getting rid of foreign material.  A spitting stitch is a normal process.  The key is to have this assessed and cared for by your surgeon.  Once the suture is removed, the inflammation resolves.  It is distinctly possible that this is causing the angry red area.  

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

"Spitting Sutures" and other Stitch problems

+2

You may be right in your analysis. From what you described you have a "spitting stitch". Essentially your body tends to push foreign bodies to the surface and once it comes in contact with the pores or skin surface it can become inflamed or infected and may cause what is called a suture granuloma.

Most important is that you need to see your plastic surgeon for evaluation and treatment.Do not delay.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

Internal Stitches in Facelift Surgery May Need to Be Addressed

+2

Dear Barty1-

 

Depending on your facelift technique, you may have sutures under your skin, in the area in front of your right ear, as you describe.  These sutures may be absorbable, or may not be, which also affects how quickly they dissolve.  

Generally, treating this type of issue can be done safely in the office, using some local anesthesia, and either removing the suture, re-suturing the right ear area, getting a possible cortisone injection, or a completely different technique, depending on what is going on with your right ear.  

 

Only a physical exam with your plastic surgeon, in person, can fully determine what's going on with your right ear, so I would suggest seeing him/ her as soon as you can.

 

Best Wishes on a Speedy Recovery!

 

Roy Kim, MD

Roy Kim, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 3 reviews

Internal stitches in facelift

+2

In many operatons now there are stitches tightening the underlying tissues n various places around the face infront of the ear. These can reject or form foreign body reactions called granuomas. A prudent probng of the area will find and remove the stitch.iAs long as the stitch is there it will continue to  weep.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 17 reviews

Redness in Preauricular Area after Facelift at 2 Months

+1

  This could be a suture abscess or irritation, and this could have been used for SMAS plication or the like.  An exam by your plastic surgeon will be necessary.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 209 reviews

Internal Sutures 8 Weeks After a Facelift

+1

The simple answer to your questions is "yes"; internal sutures can become inflamed and work their way out after surgery.  This can occur weeks, months, or even years after surgery.  In my experience, this process is more likely to occur when braided sutures are used.  Many Surgeons prefer a longer lasting form of deeper suture, such as a braided Nylon, or a PDS (monofilament) for fixation of the SMAS.  In my experience, this circumstance is most likely to occur when a braided suture is used in a male patient.  The high density of deeper hair follicles in relative proximity to the suture is likely to account for this.  Removal of the offending suture(s) is usually sufficient to solve the problem.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

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.