A quill suture poked through my armpit incisions after brachioplasty, now concerned over other areas. What should I do?

The stitches are deep but can come to the surface of your skin. If you find them very painful you should follow up with your surgeon who could remove them for you. 

Hi, TrickOfTheTail in Asheville. Thank you for your question regarding a quill suture that poked through your armpit incisions after your brachioplasty and what you should do. Most experienced plastic surgeons on not use quill sutures because the quill sutures are painful, often rejected, lead to suboptimal healing, and deliver poor overall scar appearance. Fortunately, the quill sutures used for the arm lift are dissolvable; therefore, your brachioplasty or arm lift quill sutures will eventually dissolve. Most plastic surgeons would not remove the remaining quill sutures in your arm if there are no problems. First, two months after an arm lift, the arm lift tissue is not healed enough to support the closure of the incision without sutures in place. Second, removing the quill sutures is not indicated since you are not having active problems with the quill suture. Active problems include complications like infection, wound opening, and visible and or palpable quill sutures. Worrying about possible future pain from a quill suture is not an active problem. The thought pattern for most plastic surgeons would be, "If it ain't broke, don't fix it." The cure or treatment (removing the quill arm lift sutures) may be worse than your current situation. Good lick. Thank you for your question regarding a quill suture that poked through your armpit incisions after your brachioplasty and what you should do.
Since a brachioplasty or arm lift surgery is difficult, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of arm lifts. Do your research. Make sure your chosen plastic surgeon has performed at least 100 arm lifts. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. Sincerely, Dr. Katzen, MD, MBA. (Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

I'm sorry to hear about your experience. You should absolutely see your plastic surgeon and address your concerns. I'm not sure that any more sutures will poke out (most likely), but having a professional take a look and examine you is the way to go!Best wishes, Dr. ALDO 

I would ask your PS about whether the quill's are dissolvable or not. It is unusual for quills to come out prior to them dissolving. Often surgeons not only use quills but also use some interrupted dissolvable stitches and it may be these that you are now feeling. Best to see your PS and be advised.

This is a good question. The most common area of the suture that is exposed is the knot that either ends or starts a new segment. It is not uncommon to have this happen and going to your surgeon is probably your best bet. Occasionally surgeons use permanent sutures so these must be removed before healing will proceed.  Bottom line...don't wait for a month to have these issues addressed.

It is not uncommon for sutures to "spit" or poke out after a brachioplasty/arm lift. These are challenging incisions. They can usually be clipped at the skin exit site and the incision will heal uneventfully. Schedule a followup appointment for a wound check and for this to be addressed.

Thank you for your question, and I am sorry to hear that you are having issues with your incisions. I would suggest seeing your Plastic Surgeon - there are different types of quill sutures; some are absorbable, and some are not. If you have the latter type, they will have to be removed if they extrude through the skin. Only your Plastic Surgeon can help answer that question for sure. Best of luck! 

It is always best to visit your plastic surgeon if there is an issue you are concerned about and this situation is no different. The barbs on the quill suture do have a tendency to want to spit out of the skin from time to time. It should not lead to any serious complications but your sugeon may want to be more or less aggressive with removing the suture exposures so it is worth a discussion!