Do progressive tension sutures help healing?

These are dissolvable sutures that attach the superiorly based abdominal flap to the underlying fascia, both reducing dead space and therefore avoiding seromas and reducing tension on the incision line for a better scar.  There may be slight traction dimples left on the skin that are visible but resolve as the sutures dissolve.  They can add time to the procedure but otherwise are recommended. 

Our meta-analysis (link below) revealed that a "drainless tummy tuck (abdominoplasty) with progressive tension sutures" was more effective than the traditional "tummy tuck with drains" in reducing seroma (fluid buildup) and reoperation rates, with no significant difference in hematomas or infections.
Despite these findings, many plastic surgeons continue to use drains during tummy tucks (typically since they were trained to use drains and continue this standard practice). Drains are typically used to prevent fluid accumulation under the skin, a common issue after the procedure. Fluid buildup, known as a seroma, can slow the healing process and lead to complications. Drains help remove this fluid, ensuring proper healing and minimizing complications. However, drains can be uncomfortable, require extra care, and increase the risk of infection at the insertion points. They can also leave scars, even after removal.
The introduction of the "drainless" tummy tuck, typically performed with progressive tension sutures, offers a promising alternative. These sutures close any dead space in the skin flap, significantly reducing fluid buildup and seromas. This technique eliminates the need for drains, which can lead to faster recovery times and less post-operative discomfort. While effective, this method has some challenges, such as a slightly longer surgical time and the need for a skilled and experienced surgeon. Some surgeons may still opt for drains, particularly in patients with certain body types or those undergoing significant liposuction, due to concerns about fluid accumulation. However, as evidence supporting the benefits of drainless tummy tucks continues to grow, this approach is gaining popularity for its improved patient comfort and smoother recovery process.
Though not all patients are ideal candidates for the drainless technique, it has proven to be a highly effective option. To ensure the best outcome, it's essential to consult with a plastic surgeon experienced in this technique. Incorrect placement of the sutures can lead to contour deformities or dimpling, and may require reoperation. Be sure to speak with a qualified surgeon to determine if a drainless tummy tuck is right for you!
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Progressive tension sutures have been used since the early 90's when first described by a Dr. Lockwood. They are an excellent way to distribute the tension from the abdominoplasty closure along the entire abdominal wall rather than having the tension concentrated at the incision line. Many surgeons use these as they can also help shape the abdomen and possibly reduce the need for drains. They don't speed up healing, but they may reduce complication risk. 

Hello. Progressive tension sutures help to reduce fluid collections, offload the suture line tightness for better scarring and allow the patient to stand upright immediately after surgery. Definitely there are distinct advantages. 

Some excellent plastic surgeons use drains, some use internal
quilting sutures, and some use both. Whether a surgeon uses drains or not
should be one of the least important factors in choosing the surgeon. The
choice of drains or no drains should depend on the extent of the procedure and
the surgeon’s opinion based on his or her experience. Good results have been
obtained both with and without drains. The length of the recovery and the
extent of swelling are not diminished in procedures where no drains are used.
What is far more important is the choice of the
surgeon. I would suggest you find a plastic surgeon certified by the American
Board of Plastic Surgery and ideally a member of the American Society for
Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You
should discuss your concerns with that surgeon in person. While a second or
third opinion may be worthwhile, continuing to pursue consultations until you
get the answers that you think that you want to hear may not necessarily be in
your best interest. If you are ambivalent, don’t do the procedure.
Robert Singer, MD FACS
La Jolla, California

I offer progressive tension suture Full TT as well as Full TT, mini TT, free float bb TT. I adjust to the needs of each individual patient. The major issue with the progressive TT is additional time in OR and costs of the additional sutures. Thus the fee increases by $1,000 to $8,200. I still place a very small caliber drain. 

Thanks for the question.  There is an advantage to using tension sutures for the surgery, but as expected there are also disadvantages that can't be ignored.  There may be some skin dimpling or indentations when each tension suture is placed, there will also  be a longer time  needed to perform the suture, among other considerations.  Always discuss this with your Plastic Surgeon before a decision is made.  As should be considered, the choice is less important than the experience of your Plastic Surgeon with each technique.Good luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon

Progressive tension sutures used during closure after tummy tuck can obviate the need for post-op drains.  There is a potential problem with irregular contours due to uneven tension applied across the skin flap.  Surgeons who use this method should be well-versed in the technique to avoid this potential complication.