Does the type of suture used in upper blepharoplasty affect the quality of the scarring?

Question

If so, what do you recommend?Had upper bleph 2 years ago which resulted in bad scarring (raised & lumpy) especially on right side. Surgery was performed v quickly & the suturing looked slapdash even to my untrained eye. I believe my bad scarring was caused by lack of meticulous suturing, wrong type of stitch & possibly suture material (5/0 prolene), rather than my own healing ability. Revision surgeon says it's the technique rather than type of suture which affects scarring. Is there a consensus among oculoplastic surgeons?

Stephen H. Fink, DO, FAOCO · Answer

In my experience, the design and care in closure of the incisions is important. Most people heal well in this area but there are exceptions. Some people do react to certain types of suture but rarely to removable monofilament like proline. Scars can be improved by topical products, injections, laser or even a revision if there is enough skin after the scar is fully matured.  Best to consult with your surgeon about these options.

Kenneth D. Steinsapir, MD · Answer

The care one takes in designing the incisions and how the incision is put together does matter.  However, with 73 posts, this obviously is not your only issue.  Upper eyelids can be revised if the result bothers you enough.

Lesley A. Rabach, MD · Answer

Scarring after any surgery is related to a number of factors and thus doesn't have a simple explanation. Scars occur differently in different people based on hereditary factors/genetics and such; scars can be disguised in natural creases (in the case of upper eyelids) so the design of where the scar will be is important in planning an upper blepharoplasty, and then the technique, detail, and specific type of suture used also aids in the final overall result as well as the post operative care. I hope this helps clarify that scar formation is not a simple thing.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

so technique and suture choice can certainly make a difference to the quality of scars post eye lift but in my opinion, your own healing is responsible for 50% and the technique 50%

We have all seen beautifully stitched scars heal poorly and cobbled together efforts heal almost invisibly.

Certainly if you are not happy then a scar revision is an option. I use 6/0 or 7/0 prolene so not hugely different from what you had but my advice is always that the same thing could happen again so be aware.

hope that helps.

Adam Goodwin

Samuel Baharestani, MD, FACS · Answer

I usually use a 6-0 prolene suture for my blepharoplasty cases.  It is an inert material that doesn't cause inflammation that may lead to scarring.  The eyelids are a privileged part of the body where scarring is rare regardless of the material that is used.  The most likely thing contributing to eyelids bumps or raised areas is the patient's own skin quality and if there was any gaping of the wound as it healed.  Sometimes, scar revision can improve the problem.  Wearing sunglasses outdoors will also help to prevent hyperpigmentation.  Good luck!

Wayne F. Larrabee, MD · Answer

Surgeons vary in their preference and most results are good regardless of the suture. Technique of course is important no matter what suture is used. We have used interrupted permanent sutures as well as those that are absorbed. Both can leave suture marks and tracks. We began years ago to use a  subcuticular suture that is placed beneath the skin surface and removed at one week. We have used 6-0 prolene ( a permanent suture) and been quite pleased with results and lack of complications.

Does the type of suture used in upper blepharoplasty affect the quality of the scarring?

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