Non Dissolving Stitch, Now a Knot on the Eyebrow, What Should I Do?

First, let's remember that having questions answered by strangers who have not examined you is entertainment and not the practice of medicine.

WIthout an examination and a review of your medical records, it is hard to know precisely what is going on.  Presumably there is more going on here than just a palpable suture at the eyebrow.

Standard blepharoplasty does not involve leaving suture at the brow bone.  So immediately one thinks that perhaps a browpexy or internal brow fixation was done.  This  should have been discussed with you before surgery,  in which case, the presence of a palpable suture at the eyebrow should not be a big surprise.  If the doctor did this as an undiscussed aspect of the blepharoplasty, it does not make him a bad doctor, this might be considered part of the paragraph in the consent that says you give your surgeon the power to use his or her discretion to modify the surgery as necessary.  However, most eyelid surgeons would discuss this with you ahead of time.  Explanations after the fact don't inspire confidence.

If your surgeon does not know what this bump is, I personally would be reluctant to advise you to have them explore it surgically.  If they are telling you that it is a suture, then they also have some explaining to do.  If the suture is absorbable material, I would give it many more months to completely disappear and save yourself a procedure.

If your surgeon it not making a whole lot of sense to you, I would recommend getting a second (or third) opinion even if these other doctors simply confirm that the surgeon you are seeing is on the right track.  Hope that helps.

  Probably a little more information would be helpful, namely what type of suture the surgeon used.  If it is a dissolving suture, I would elect a wait and see approach.  But if it is a permanent suture and it is bothering you, then I would ask your surgeon to remove it.  I do not think there is much risk of drooping of your eyelid or brow from doing this.

Worst mistake ever?

It is usually a 3 minute procedure to remove a retained suture, and patients can typically do this under local anesthesia and go to lunch afterward.

Hi there,

Occasionally, surgeons will choose to use internal sutures during blepharoplasty.  Reasons for the sutures may include internal brow supporting sutures, internal canthal tightening sutures, and orbicularis muscle tightening sutures in lower blepharoplasty.  All these scenarios would involve having the suture pass into the orbital rim along the upper outer section of the orbit.

These sutures can cause focal local swelling and/or tenderness in the first few months after surgery.  As long as there are no signs of increased swellng or redness, I would not be worried about risk of infection.    Also, it is not uncommon for there to be asymmetry in the healing process, and so swelling/irritation on one side is a can certainly happen.

I would be patient and let things heal more.  Continue to have an open dialogue with your surgeon about this issue. He or she may need to intervene if many months go by and you still have a little swelling or tenderness. Your surgeon may at that time decide that a minor procedure to excise the offending suture or to inject an antinflammatory medication may be an option.

Best wishes to you

Hi.  The first thing you have to figure out is why there is a stitch in the eyebrow after Blepharoplasty.  It probably indicates that the surgeon probably fixated your eyebrow.  If he is afraid to remove it , it is probably because he thinks the brow will fall.  Given that, you have to have a frank discussion with him and figure out the risks and benefits of removing the suture.  How much does it bother you?  Would you accept the risk of a brow droop with removal?  Would you undergo a revision if needed?  Good luck.

Your surgeon should be the one to tell you what this is and he is capable of correcting the problem when time is right. We are only guessing what the problem is and it is not a good thing. Sometimes doctors tell the patient that they have to wait for healing to complete but patients want immediate satisfaction and may say the doctor was baffled! So, please follow up with your surgeon and follow his instructions.

I have stoped using rapidly disolving sutures because they are unpredictable. The real question is, what was the purpose of that stitch? If it was only to close skin, I would remove it. However, if it is supporting deep structures, only your doctor can advise you

Dear Worst Mistake Ever,  Hopefully you are not talking about this surgery you just had being a mistake, and that you have an overall result that you are pleased with?!    Is the suture meant to be a dissolvable suture??..if so, it may take another month or 2 to dissolve..if it isn't causing any significant problems, I would wait another few months and in the meantime you can try warm compresses on it and aggressive massage..this tends to help things settle a bit faster..if it is an issue after another month or 2, it can be removed, and by that time you will be well healed up and shouldn't worry about a droopy lid because things will be pretty firmly approximated by then.

 

Good luck

Jasmine Mohadjer MD

Oculoplastic Surgeon

Tampa Bay, FL

I'm so sorry you've experienced a set-back following an upper and lower blepharoplasty.  I'm a little confused by your question as most upper blepharoplasties do not extend up to the eyebrow?  Photos would be really helpful.  I'm assuming you are referring to the most outside portion (lateral aspect) of your incision line - right over the outer orbit?

If that's the case, a retained stitch can easily be removed.  Retained stitches can cause a small stitch abscess resulting in the tenderness and sometimes redness to the area.  An abscess is simply a collection of fluid around the retained stitch.  The  treatment is to unroof the abscess and drain it out - done with a small needle and if necessary, local anesthetic.  Any remaining suture can then be removed at the same time.

It would be highly unusual for you to have any sort of consequences from removing this stitch.  Your eyelid shouldn't drop and you shouldn't have any other problems.  Occasionally the area of the stitch can remain a little inflamed and you can sometimes have some slightly excessive scarring in the area - if that's the case, the treatment involves an injection of steroid solution (Triamcinalone/Kenalog) and massage.  

Again, its very challenging for me to comment without examining you.  I'd suggest following up with your surgeon and discussing your concerns.  Hopefully you can work together with your surgeon to find a solution that will make you happy.  If you don't find resolution there, you can always seek a second opinion.

Ask your doctor if he used a dissolving suture. Oten a suture is placed in this location to elevate the corner of the eyelids after Blepharoplasty.

Typically Vicryl or other long lasting absorbable sutures are used and these can take months to dissolve.

Ask your doctor if its OK to massage as this can speed dissolution.

If the doctor used a permanent suture it is easy to remove