Can Internal Stitches Work Their Way out After a Face Lift?

Surgeons use
a variety of different techniques for closing the incisions after surgery. If
your surgeon only uses superficial stitches, all of these may be removed
between 1-2 weeks after surgery. I utilise three layers of deep
stitches in closing the incisions to ensure no tension on the wound, with the
intention of leaving the finest possible scar. These specific stitches dissolve
as much as 6-months after the surgery, ensuring that the soft tissues are held
in place during the healing period. On occasion as the swelling resolves the
very edges of theses stitches can be felt along the incision line, these
stitches are difficult to see as they are clear in colour. If they are
irritating or uncomfortable they can be removed, however they are not causing
any issues they can be otherwise left as they will naturally dissolve between 3
to 6 months after the surgery. There are deep stitches beneath the skin that
dissolve between 3-6 months, these are important as the support the face during
healing and reduce scarring. Sometimes as the swelling goes down, you can feel
an edge of a stitch. The stitch will dissolve, if it is uncomfortable, I can take it out for the patient.

 It is difficult to know the answer to this without consulting your surgeon. Some surgeons use very long-lasting absorbable sutures to hold up the underlying tissues (The SMAS)  in a facelift, while most use non-absorbable  polyester signatures. These can very rarely erupt through the skin. In any case you should consult with your surgeon as he or she would know what type of suuture was used 

  This could be a suture abscess or irritation, and this could have been used for SMAS plication or the like.  An exam by your plastic surgeon will be necessary.  Kenneth Hughes, MD Los Angeles, CA

The simple answer to your questions is "yes"; internal sutures can become inflamed and work their way out after surgery.  This can occur weeks, months, or even years after surgery.  In my experience, this process is more likely to occur when braided sutures are used.  Many Surgeons prefer a longer lasting form of deeper suture, such as a braided Nylon, or a PDS (monofilament) for fixation of the SMAS.  In my experience, this circumstance is most likely to occur when a braided suture is used in a male patient.  The high density of deeper hair follicles in relative proximity to the suture is likely to account for this.  Removal of the offending suture(s) is usually sufficient to solve the problem.

You may be right in your analysis. From what you described you have a "spitting stitch". Essentially your body tends to push foreign bodies to the surface and once it comes in contact with the pores or skin surface it can become inflamed or infected and may cause what is called a suture granuloma.

Most important is that you need to see your plastic surgeon for evaluation and treatment.Do not delay.

Dear Barty1-

 

Depending on your facelift technique, you may have sutures under your skin, in the area in front of your right ear, as you describe.  These sutures may be absorbable, or may not be, which also affects how quickly they dissolve.  

Generally, treating this type of issue can be done safely in the office, using some local anesthesia, and either removing the suture, re-suturing the right ear area, getting a possible cortisone injection, or a completely different technique, depending on what is going on with your right ear.  

 

Only a physical exam with your plastic surgeon, in person, can fully determine what's going on with your right ear, so I would suggest seeing him/ her as soon as you can.

 

Best Wishes on a Speedy Recovery!

 

Roy Kim, MD

Anytime there is a sudden change after surgery even at 8 weeks out, you doctor needs to be notified.  Symptoms such as redness, warmth, swelling, or a new dent could range from a minor issue to something more serious.  It is very likely that there could be a reaction from an suture underneath the skin, but there are other causes that need to eliminated, infections, skin breakdown, and other rare causes.  In this situation, I would have your doctor see the red area ASAP.  

 

I hope this helps!

Burried suture, permanent or absorbable can become inflamed.  The process is call "spitting."  It is the body's way of getting rid of foreign material.  A spitting stitch is a normal process.  The key is to have this assessed and cared for by your surgeon.  Once the suture is removed, the inflammation resolves.  It is distinctly possible that this is causing the angry red area.  

This could be a stitch. Some sutures / stitches are more likely to work its way out. Braided sutures that are non absorbable. That is why I usually use nylon stitches that are nonabsorbable that are single filament and not braided. These don't react as much. You might need to have these removed.

It's possible that you have a suture granuloma. This occurs when the suture underneath the skin that is anchoring the muscle takes longer than normal to dissolve and for whatever reason, the body mounts an inflammatory response. The result is that the suture can work its way to the surface and create a "spitting" effect when there is a small amount of drainage around the suture. On the rare occasion that this happens to me I will typically put the patient on antibiotics and try kenalog (steroid) injection into the area of inflammation. If this still does not resolve the inflammation the suture may have to be removed. 

Without seeing pictures it is difficult to determine what would be causing an elongated dent on the side of your face. If a drain was placed in that region it can sometimes heal with a ridge however this will usually fix itself within a couple of weeks. There are several other possibilities. I would follow up with your surgeon for further analysis.