I'm concerned about scarring from open Revision Rhinoplasty with dissolvable stitches over columella. How long until they fall out? Do dissolvable stiches in this area mean more or less scarring? Any downsides?
Scarring Concern from Open Rhinoplasty with Dissolvable Stitches
Doctor Answers (9)
Revision Rhinoplasty: Suture Choice Less Important than Surgeon's Skill
The type of suture (stitches) used to close the columellar incision (incision between the nostrils) in open rhinoplasty has less of an impact on the visibility of the scar than the surgeon's skill and attention to detail.
While dissolvable sutures such as "chromic" and "fast-absorbing-gut" have been shown in studies to produce slightly more tissue inflammation than permanent sutures such as "nylon" or "prolene", excellent wound closure can be attained with dissolvable sutures.
Dissolvable sutures should remain in place for a minimum of 5-7 days to ensure that the incision has healed shut adequately. Most of these will dissolve sometime in the 7-14 day time period. Follow your doctor's recommendations on wound care to ensure that you get the best possible result.
Scarring after Rhinoplasty skin incisions
Your columellar skin incision will typically heal well, regardless of the type of suture. We frequently use absorbable sutures in the facial skin.
These stitches always fallout. If they are irritating you, ask your surgeon to remove them.
Open Rhinoplasty Incisions
Incisions in the columella of the nose tend to heal well regardless of the type of suture used. If the skin edges are well aligned and allowed to heal for an appropriate time the results are usually excellent. If the dissolvable sutures have not fallen out by two weeks the surgeon will usually remove them.
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Open Rhinoplasty incisions heal well in just about everyone.
Revision rhinoplasty is one of the most difficult, humbling operations I perform. I couldn't imagine getting a favorable, predictable result without the small columella incision.
I typically use 3 permanent sutures, and 2 absorbable sutures to close the columella. This is done purely out of habit, since that's the way my mentor trained me 11 years ago. I think this incision has a high likelihood of healing well no matter what stitches are placed. All of these sutures are removed 7 days after surgery.
You should be confident that your surgeon is board-certified, and an experienced rhinoplasty surgeon. You should also see many favorable photos before proceeding.
I hope this helps, and best regards.
Open rhinoplasty scarring of the columella
Open rhinoplasty scarring and scars
I have a very specific protocol for my open rhinoplasty surgeries, in which I use prolene sutures for the skin and absorbable for the mucosa. This yields excellent scars.
Generally dissolvable sutures work well
Generally dissolvable sutures work well, and dissolve within 7-10 days. Any incision on the nose will take about a year to mature. You can also consider fractional laser on the scars to reduce any scarring even further. Follow up with your physician to ensure he/she is happy with the outcome.
Suture choice for open rhinoplasty incision
The open rhinoplasty columellar incision can heal well with both dissolvable sutures or non-dissolvable sutures that are then removed around 1 weeks after surgery. Some surgeons use a combination of both types in their closure.
How the incision heals has more to do with surgical technique and post-operative care than the actual type of suture used. Look at photos (you'll need to see the base view) of your potential surgeon's after results to see how well their incisions heal. If you follow the prescribed incision line care the dissolvable sutures should come out on their own after 10-14 days or so. Your surgeon can remove them at any time after 1 week postoperative (just like removing non-dissolvable sutures) if needed though.
Scarring not a concern with open rhinoplasty
The incision between the nostrils heals extremely well as seen on the link below. I typically use non-dissolving sutures since they can be removed when I want the to vs. leaving them to dissolve on their own.