Should I go with permanent or dissolvable stitches inside my nose for rhinoplasty?

Question

Im getting Rhinoplasty and my Plastic Surgeon has said he can put either permanent sutures /stitches inside my nose or dissolvable ones. I hear that permanent ones would potentially help keep the nose in place better that dissolvable ones but they could get infected (although he says that's unlikely) or potentially be rejected by the body. Please can you advise me on the best choice or the most common choice? Thank you!

Evan Ransom, MD, FACS · Answer

Thank you for the great question. First, suture selection in rhinoplasty is a bit of an esoteric topic and I am a little surprised that this choice was put on you. Second, most surgeons have clear preferences that they develop in training and building their practice; these are specific to the ways that they handle the tissue and are not "right" or "wrong" in any way. In my rhinoplasty practice, I use long-acting absorbable sutures inside the nose (e.g., PDS or vicryl). For the skin layer, I use nylon and remove these about a week after the surgery. Mucosal stitches are generally performed with a shorter-acting absorbable material, such as gut sutures. Best of luck and take care!

P. Daniel Ward, MD · Answer

Hank you for the question. There is not a wrong answer to your question. Either is fine. I personally use dissolvable sutures.

Tim Sayed, MD, MBA, FACS · Answer

This is odd that a surgeon would ask you to select sutures. Most of us have standard practices and although it may different from surgeon to surgeon, any individual surgeon will usually have a protocol. I use PDS suture for the cartilage as it is slowly absorbable and gives good fixation, though I have used clear nylon in the past too. I use nylon across the columella in open tip rhinoplasty and use chromic gut sutures that absorb on the mucosal layer.

Michael M. Kim, MD · Answer

Hello ChristmasDay,It's a little odd that the surgeon would present you with the choice of suture materials inside your nose. It's one of those things of which there is no consensus. Some use permanent, some use dissolvable, and some use both. I don't think that it has a material difference in your result and it's probably not important enough to waste your energy thinking about it!Michael M. Kim, MD

Mohsen Tavoussi, MD, DO · Answer

There are permanent sutures that may be used to approximate the nasal cartilages or secure grafts but skin and mucosa are always closed with absorbable sutures.

David A. Sieber, MD, FACS · Answer

Thanks for the great question! I find it a little odd that your surgeon gave you the option of permanent vs dissolvable sutures for your surgery. Myself, as long as many of the best rhinoplasty surgeons in the country use dissolving sutures such as PDS and Vicryl for the procedure. Those sutures last long enough for the body to form scar tissue, but they do not cause any long term issues that you may see with permanent sutures. I hope this helps!Best,~Dr. Sieber

William Portuese, MD · Answer

In our practice for over 26 years, we have used dissolvable stitches inside the nose. They just fall out on their own at approximately one week. The type of stitches has got nothing to do with  keeping the nose in a better place or infection. Rhinoplasty is a very difficult endeavor, so choose your specialist very wisely based on extensive experience. Study your prospective surgeon's before and after rhinoplasty photo gallery which should be extensive and reflective of their work.

Should I go with permanent or dissolvable stitches inside my nose for rhinoplasty?

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