Are Subcuticular Sutures the best option on the Upper Eyelid?

Question

I have read about interrupted subcuticular closures on upper eyelids and the very fine scars and fast healing. In these forums, it has been said that mostly plastic surgeons use subcuticular sutures, but not so many oculoplastic surgeons. For surgeons with experience, do you agree subcuticular sutures are the best option for lids? Is it a recently developed technique that oculoplastic surgeons have not adopted yet? Just wondering if it is possible to request this technique of an oculoplastic surgeon.

Jeffrey M. Darrow, MD · Answer

Subcuticular sutures are placed under the surface of the skin.  As the upper eyelid skin is thin, a very fine suture is used to repair the incision. There is no need to do interrupted subcuticular sutures as each stitch must be a dissolving stitch as it will not be removed and  would require a knot where the stitch is tied.  This collection of dissolving suture material under the skin will create a reaction as your body dissolves it and can result in a more reactive, red raised scar.  The best option is a running, ie continuous suture, of permanent/nondissolving suture material, which does not create the reaction in the scar as your body is not trying to dissolve the suture.  The stitch enters one end of the incision and goes back and forth between the edges of the incision and exits the other end of the incision.  Removal of the suture is simple, just cut one end of the suture and pull the other end and the stitch simply pulls out.  This is how I close all of my upper blepharoplasty and lower blepharoplasty incisions. Any well trained plastic surgeon should be able to use this technique. Best wishes.

Anshu Gupta, MD · Answer

Both interrupted and subcuticular closure techniques can yield excellent results in experienced hands. The key factor is not necessarily the technique itself, but how precisely it's executed. That said, we generally avoid absorbable sutures for subcuticular closures on the eyelids, as they can sometimes lead to a thicker scar due to tissue reaction during absorption.
In our practice, we prefer using fast-absorbing gut (like 5-0 fast gut) placed in the skin, which tends to fall off naturally within about 5–7 days and typically leaves very minimal scarring.
This technique is not necessarily new or limited to plastic surgeons&mdash;many oculoplastic surgeons use variations of it depending on patient factors and personal preference. If you’re interested in a particular closure technique, it’s absolutely reasonable to discuss it with your surgeon during consultation.

Lexie Wang, MD · Answer

this is 100% dependent on the surgeon operating. the upper eyelid region honestly heals so well that I doubt it matters significantly which style a surgeon uses. i personally do not use subcuticular here but I doubt there is a significant difference. this is not something I would dictate of your surgeon; let her do it the way she has always done it.

David K. Isaacs, MD, FACS · Answer

As an Oculofacial plastic surgeon who has trained in both Oculoplastics and facial plastics I can tell you that although every aspect of surgery is important, the method of closure is much less important than the other technical details of the surgery.

Subcuticular sutures are certainly not a recently developed technique and Oculoplastic surgeons are definitely on the cutting edge (no pun intended) when it comes to pioneering advances in plastic surgery.

Also, there are certain techniques that you cannot do with a subcuticular closure, so that’s also not very advantageous at times.

See an expert for an evaluation. Hope this helps!

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!when it comes to closure techniques each has it's own benefits and potential issues , I have used a running absorbable suture before and I am currently using a running subcuticular permanent stitch with some interrupted external sutures for security , they both work great both work great , the absorbable ones save you he hassle of taking them out later but in certain people I feel that they had some reactions to it , I like the subcuticular ones but I feel that you still need some interrupted sutures on top for security so there is the hassle of taking all those out . Whatever the case is the upper lid is very forgiving and for the most part the people are pleased with their scars once fully healed. That being said a huge percentage of how the scar ends up looking is dependent of the patient's biology and how they scar.I hope this helps, best of luck!

Are Subcuticular Sutures the best option on the Upper Eyelid?

Answers (9)

Answer: Upper Blepharoplasty Suturing

Answer: Upper Blepharoplasty Suturing

Answer: Subcuticular sutures

Answer: Subcuticular sutures

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Are Subcuticular Sutures the best option on the Upper Eyelid?

Answers (9)

Answer: Upper Blepharoplasty Suturing

Answer: Upper Blepharoplasty Suturing

Answer: Subcuticular sutures

Answer: Subcuticular sutures

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.