Suture granuloma after rhinoplasty 14 years ago? (Photo)

Question

Hi, I had a rhinoplasty back in 2003. Over the past couple of years, I’ve been experiencing redness and irritation where the incision/sutures were and also a big whitehead on it about twice a month. I just noticed something coming out of the skin, and it’s a string of a bright blue suture. Since it has been left in all this time has it been causing my problem? How can it be fixed? Would I have to have surgery again to get the red bump area removed and to remove the suture?

Scott Trimas, MD · Answer

It seems as if the suture may be working its way to the surface and acting as a foreign body and irritating the underlying tissues. Typically, some local anesthetic is used to numb up the area in the office and the suture can be removed and this should cause your nose to settle back down. Good luck in your area.

Yannis Alexandrides, MD, FACS · Answer

This looks like a suture that the Doctor probably placed on the cartilage underneath the skin which has now been exposed. You should see your surgeon to remove this suture, otherwise it could cause further irritation. It's possible that once the suture has been removed, the redness will go away,

Brian Maloney, MD, FACS · Answer

I would follow up with your surgeon. Should be a quick fix for you.Deep sutures help to hold the tissues in place during the healing. Ocassionally the body may work it up to the surface. Removal of the suture is generally will take care of the problem.

John Michael Thomassen, MD · Answer

A small suture is present and is likely the cause of your symptoms.  You can have this removed at the office without having to go through surgery.

Eric M. Joseph, MD · Answer

My rhinoplasty teacher switched from blue, permanent Prolene (Ethicon) sutures, to long-lasting absorbable sutures around two years after my fellowship for exactly this reason - occasionally permanent sutures are rejected and cause recurrent inflammation until removed. Your suture looks outside the skin in your photo, so removal should not require major inconvenience. Hope this helps! Dr Joseph

Alexander Zuriarrain, MD, FACS · Answer

Hello and thank you for providing such an excellent photo!It seems to me that you have a suture granuloma and a piece of non-absorbable suture material (looks like prolene) is trying to make its way out of the wound edge. This is typically a very simple fix and all that is required is to remove the embedded suture material in its totality to get ride of the problem. This can be done by any plastic surgeon and is performed with local anesthesia.All the best!Alex Zuriarrain, MDCleveland Clinic Trained Plastic Surgeon

Callum Faris, MD · Answer

I am sorry to hear of your troubles. You should contact your facial plastic or plastic surgeon to help manage this situation. Occasionally permanent sutures (bright blue is likely to be prolene suture) can spit through the skin after rhinoplasty. The usual treatment is to remove the offending suture under local anaesthetic. This is a quick procedure. It is likely the repeated white heads were caused by the suture as it migrated up to the skin surface, the good news is that the area should settle when it is removed. Removing a suture at this stage will not have an effect on the stability of the nose as the tissues are held in place by scar tissue. I hope this helps.

Paul N. Afrooz, MD · Answer

Permanent suture is sometimes used in rhinoplasty to reshape the cartilage.  The use of permanent versus absorbable/non-permanent suture is surgeon dependent, and neither is right or wrong.  Many surgeons like to use permanent sutures, although there are studies that show that absorbable/non-permanent suture is just as effective.  
This permanent suture is almost certainly the cause of your recurrent small local infection.  Particularly now that suture is extruding, it should be removed.  Accessing this suture safely to remove it in its entirety, and any sutures in the immediate proximity to this one should be done carefully and by an experienced rhinoplasty surgeon.  This will ensure proper removal, alleviation of your recurrent local infection, and proper healing with an inconspicuous scar.

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