Are Subcuticular Sutures the best option on the Upper Eyelid?

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.

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—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.

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.

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!

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!

This is a great question!
I think sometimes things can be a bit exaggerated on social media or online as to different mechanisms and their impact on surgery in an effort to stand out to potential patients. For example, the subcuticular suture looks great on video because you can see the demonstrable difference. However, in terms of results, there have been no definitive research studies that show a significant difference in technique of suturing and impact on outcomes for an upper blepharoplasty. What matters the most, is how the rest of the surgery is performed and how the tissue is handled during closure, not the suture technique.
Hope this helps and best of luck! Kyle Kimura, MD

The best advise is look at before / after photos from the surgeon you connect with and then let them do their work the way they do. Would you ask a mechanic what wrench is used? A good surgeon will get you a good result. Many of these details are unimportant, have minimal impact, or used as part of marketing to try to create hype where none belongs.

There are many different options for upper lid blepharoplasty closure and there is not a consensus on the best option. I prefer a subcuticular Prolene suture that is pulled out 7 days after surgery but simple interrupted fast absorbing sutures will work well for many patients.

No matter what type of sutures you use or suture technique, the incision itself will be pink and lumpy bumpy for 2 to 3 months after upper eyelid surgery. Much more important is to look at the surgical results, and not worry about the type of sutures used during surgery. We use dissolvable sutures so that they don't have to be removed in our practice. We also perform upper eyelid surgery under local anesthesia, so patients can walk in and out of the office.