What Kind of Stitches Are Used in Rhinoplasty?

Question

Do they dissolve or are they taken out? Do I have a choice? My friend had rhinoplasty last month and she had 16 stitches. She said getting the stitches removed was more painful than the surgery.

Thomas A. Lamperti, MD · Answer

There is a lot of variation among surgeons regarding what type of sutures are used during rhinoplasty surgery. It also depends on whether an open or closed approach was used as well. There is typically a few incisions inside the nose that are closed with dissolvable sutures that go away on their own.

	If an external incision is used (with an open approach) there are a few sutures along the small incision across the columella. These sutures are often a permanent type that need to be removed about a week after surgery. I prefer using a very fine dissolvable suture (7-0 chromic) in this area in which I only need to trim the knots out at the one week visit.

Louis M. DeJoseph, MD · Answer

Typically two types are used depending on the saurgical technique.  Permanent or dissolvable sutures can be used.  Typically most rhinplasty is performed with long term absorbable sutures which dissappear over 6 months.  By that time all the tiisue has healed in position and the suture is no longer needed.  There are occasions where we will use a permanent suture for more long term security.  Hope this was helpful.

	 

	Best

	 

	Dr D.

Eric M. Joseph, MD · Answer

All of the sutures inside your nose will be dissolve and typically fall out within the first 3-4 weeks after your Rhinoplasty. At the base of your nose, you may need between 5-15 delicate sutures: 5 without nostril work, and 11-15 if you require nostril narrowing. These external sutures may be either permanent or dissolvable, depending on the preference of your surgeon.

	Hope this helps.

	Dr. Joseph

William Portuese, MD · Answer

We use dissolvable sutures that dissolve within 1 week after the surgery.  No suture removal is needed after a rhinoplasty.

Robert Kotler, MD, FACS · Answer

Hi Saiqa;

	There are probably as many choices of stitches (medically called sutures) in rhinoplasty, as there are surgeons performing it.  You need to know that there are two basic kinds of sutures.  The first class of sutures is the suture thatl dissolves over time.  Some dissolve within 7-10 days, and others can take up to three months.  The plastic surgeon decides how long he needs the sutures in place.  The other kind of sutures are non-dissolvable, or so-called "permanent," or "removable."  These must be removed.  Typically, these are the type of sutures that are used on the outside of the nose.  The dissolvers tend to be used on the inside of the nose, and the non-dissolvers tend to be used on the outside.  The outside incisions that typically would employ the non-dissolving sutures, are the open rhinoplasty incision, which is done between the two nostrils.  The other external incision is that used to narrow the nostrils, which is typically placed in the groove between the wings of the nostril and the upper lip and cheek.

	Typically, outside non-absorbable sutures are removed somewhere between 5-7 to possibly 10 days. 

	Surgeons tend to use the thinnest or finest suture material possible on the outside, since they are much less apt to cause any "railroad tracking" or cross-hatching.  In the end, your suture line should blend into a normal crease and look natural without calling attention to itself.

	Robert Kotler, MD, FACS
	Facial Plastic Surgeon
	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
	Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Steven Wallach, MD · Answer

Stitches can be absorbable or non-absorbable. Usually non-absorbable sutures are place on the skin and removed within about a week. It hink they are less reactive and the skin heals better. I use many internal sutures that are absorbable and do not need to be removed.

James Tang, MD · Answer

Usually there are a combination of dissolvable and non dissolvable sutures involved in closing a rhinoplasty. It depends somewhat on the technique of the surgeon. An open rhinoplasty will more likely involve some sutures that have to be removed. While intranasal incisions may involve dissolvable sutures. However, when dissolvable sutures are used, it is quite likely that they do not dissolve fast enough and may end up being removed also.

Peter A. Aldea, MD · Answer

Stitches used in surgery can be divided into 2 large classes: Dissolving and Permanent. In general we use dissolving stitches when we know the body's healing and scar tissue will glue things together and there is no long lasting need to leave a foreign body holding things together. Permanent stitches are used when we want to make sure there is no movement even after healing has completed OR because they are non-reactive they are used to get the best possible skin scars.

	In nose surgery, the cartilage surgery is often done with either permanent or long lasting dissolving smooth stitches. The wounds inside the nose are always closed with dissolving stitches BUT the skin stitches are often done with permanent stitches which are removed around 5 days. 

	Suture removal is at most, uncomfortable. It is rarely incapacitating. Respectfully, I think your friend is slightly over playing it.

James Green, MD (retired) · Answer

Stitches that are placed inside the nose are typically dissolvable, unless they are used for structural enhancements. In those cases stitches may not be dissolvable, but they are also typically not visible and buried in the tissues.  Sutures on the outside of the nose are typically also not dissolvable and should be removed after three to five days.

Francis R. Palmer, III, MD (retired) · Answer

I would guess that different Rhinoplasty Surgeons use different stitches. I use dissolvable stitches for all closed Rhinoplasty and even in the front for open Rhinoplasties, so nothing has to be removed.

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