How many layers of stitches are used in a full tummy tuck? Are they permanent or will they dissolve?

Hello,I'd tell you but am afraid you're going to start doing them yourself! ;)Seriously, there has been few studies looking at different suture types and how the results compare.  I think it is more about the other things we do that make a difference in the results of a tummy tuck: abdominal contour, belly button shape, scar quality, and scar placement. For example, when suturing the long lower incision closed, when the 'superficial facia' is sutured together, a layer deep to skin inside the fatty layer, it takes tension off of the skin closure, making for a finer scar.Most surgeons use a permanent suture for muscle plication; the long term strength of this suture is needed for many months past when absorbable sutures dissolve. Most of the other sutures are dissolvable.  Regarding layers, every surgeon has a preference. I made the decision a few years ago to not only sew together the divided layers (muscle to muscle, fascia to fascia, dermis to dermis, epidermis to epidermis), but to also sew the subcutaneous layer down to the deeper muscle layer.  This technique called 'quiliting sutures' allows me to forego the use of drains, and has prevented what use to be a common complication: seromas, or fluid collections under the skin flap.  It also tightens the upper abdomen better than when I didn't use this technique.I hope this has been insightful. Best of luck!

  I would select your surgeon based upon before and after pictures, reviews, and credentials.  The technical aspects of the surgery are important, but it is difficult as a patient to differentiate salesmanship and marketing from expertise.  Kenneth Hughes, MDBeverly Hills, CA

I wouldn't get hung up on the suturing technique.  It's best to close in layers to lessen the tension and achieve excellent alignment.  The muscle fascial plication is performed with permanent and or absorbable sutures.  I prefer both.  

It is possible that there are 4 layers of suturing:The muscular fascia:  This is the deepest layer and typically involves pulling together the strectched out fascia or "diastasis recti".  This midline is designed to stretch with pregnancies but doesn't snap back very well.  The repair essentially brings the rectus abdominus (six pack) muscles back together giving another dimension of tightening of the abdominal wall.  Another possible repair in this layer is called "progressive tension suturing" which approximates the muscle fascia to the overlying subcutaneous scarps layer.  This technique reduces the tension of the final skin closure and helps to reduce seromas (decreasing the need for prolonged drains).Scarpas layer:  This is a fibrous layer within the subcutaneous fat and is important in the final closure of the  skin in reducing tension.Deep dermis:  This is the deep white part of skin that is sutured without  penetrating the outside surface.Dermis-Epidermis:  This is the outer layer where a fine subcuticular (under the skin) closure or external closure can  be done.The muscle fascia should be closed with a permanent suture because absorbing sutures don't last long enough to allow adequate healing of the high tension closure.  The other layers can be done with absorbing sutures all under the skin. 

Suturing techniques vary quite a bit from doctor to doctor.Some use self-dissolving sutures, others permanent sutures.  Some use mesh, others hate it.  Some have sturdy deep layer closures, others don't.  Some use self dissolving skin sutures, others pull-out sutures.  Drains/no drains.  Pumps/no pumps.  Aftercare/no aftercare.  Different dressing types.  Different postoperative limitations.While there should be a good rationale for which sutures are chosen, would the average consumer be able to make heads or tails of these choices when doctors obviously haven't?  After all there are so many different methods still being used!  More important still is what type of tummy tuck to choose.  There are many options.It is probably more productive to focus on what the experience of other patients have been with a given surgeon, the credentials of the doctor, his or her bedside manner, the experience during the consultation, and, most importantly of all, that 'gut instinct' once all factors have been considered.

I think most plastic surgeons surgeons do more or less the same thing when it comes to tummy tuck suturing with some small modifications. I use a very strong layer of permanent sutures to tighten the muscle, then I use 3 layers of dissolvable sutures to close the skin flap starting deep and moving to just under the skin surface. Surgical glue is then used to seal the skin which protects, waterproofs and treats the scar while the glue is in in place for 3 weeks or so. If one uses minimal suturing the patient is more apt to end to end up with a widened and depressed or indented scar.  I hope this information helps!Thomas Taylor, MD, FACSPasadena, CA

The suturing techniques by plastic surgeons for a tummy tuck are usually very similar.  I close with a three layer closure. I use permanent sutures to plicate or tighten the fascia and then we close the lower abdominal incision with three layers.   We use Embrace which is silicone sheeting to help the scar look the best.   Best to look for a Board Certified Plastic Surgeon. Good luck!  Andrew Cohen, MD

Thank you for your question. Each plastic surgeon has his own specific technique but it's safe to say that the vast majority close a tummy tuck incision in at least 3 layers using absorbing sutures. There are far more important issues for you to be concerned about in my opinion including how high or low the incision will be made and the genetic quality of your own healing. As long as the stitching is done internally genetics becomes the most important issue to determine whether your scar will be light, dark, thin or possibly prominent. There are also taping devices now available that may help to lessen (but not eliminate) the visibility of your lower abdominal scar. Good luck to you and best wishes for an easy recovery.

I seems you already have the answer as to how your surgeon does the closure. There are many ways to accomplish the result. I don't understand why you would care about suture technique when your concern should be results.