Do doctors usually use permanent and visible sutures under the skin for a Tummy Tuck?
Permanent and Visible Sutures for Tummy Tuck: Normal?
Doctor Answers 15
An abdominoplasty has three parts:
- Tightening the muscle
- Removing the skin and fat
- Contouring the skin envelope by the closure
In my practice (as is typical for most board certified plastic surgery practices), permanent suture is used to tighten the muscle (the rectus plication). These sutures are typically covered by the tissue overlaying the muscle.
A surgeon may also use permanent sutures that are remove to secure the drains - obviously, when the drains come out so should the suture.
For the skin closure, my practice always uses absorbable suture. We've had excellent results with this.
There may be some practices that use a permanent suture, but that should be removed when the incision has sufficiently healed (typically 5-7 days).
I hope this helps.
Both permanent and temporary sutures
Most plastic surgeons will use a combination of permanent sutures for the repair of the fascia. Sewing the deep layer together with heavier absorbable (self-dissolving) sutures.
The deep fascial sutures are very rarely palpable, even in our patients with very low percentage body fat.
Often, sutures work their way to the surface "spit" and need to be removed, even if they are self-dissolving sutures. No sutures should be visible after all healing is complete.
Most surgeons use self-dissolving sutures for the skin. However, non dissolving sutures are fine for the skin as long as they are not done in the "over-over stitching" style, which tends to yield poor scarring and small white dots on both sides of the incision.
Yes permanent and absorbable sutures are used in Tummy Tucks
There are a variety of options available for wound closure.
However, there is one general trend. Most surgeons use permanent sutures for the muscle repair.
You must understand that permanent sutures don't always assure a permanent result of effect. Let me explain with an analogy.
IF you graft two tree limbs together, duct tape (= permanent suture) is commonly used to hold them together unitl they heal. Once they heal, the tape (suture) can be removed.
In performing a muslce repair, we often use permanent sutures in the same fashion. Some surgeons feel that the muscles never truly heal together. However, the scar tissue surrounding the repair tends to subsitute for the sutures over time and hold the muscles together. This does not mean that subsequent pregancies or weight gain could disrupt the repair.
In regards to the other layers, there is great variation in the techniques used with some surgeons using permanent sutures in the SFS layer.
Some surgeons use permanent sutures immediately below the surface of the skin with the belief that this will prevent the scar from becoming wide. However, this sets up a potential condition where sutures can "spit" for the rest of your life due to the proximity to the skin surface and can become a nuisance.
Regardless of technique or sutures, some people heal with excellent scars while others heal undesireably.
I have overly simplified this complex and debated subject but I hope this helps you gain a better understanding.
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Sutures too close to the surface
The best new techniques in tummy tuck surgery, demonstrated by Dr. Ted Lockwood, utilize permanent sutures at the fascial level to take tension off the skin, so it can heal without wide, unsightly scars.
The fascial level in most patients is midway between the skin and the muscle. This is usually enough distance from the suture to the skin so that these sutures are not visible or palpable.
In a small group of patients, there is so little fat within the abdominal skin that the sutures will be palpable and visible. For the rest of us with more fat, the sutures will be hidden if placed in the proper plane.
Yes doctors sometime use permanent sutures, but only in the deep tissues
During a tummy tuck or abdominoplasty surgeons often use permanent sutures in the deep tissues to repair the rectus fascia. These are not seen through the skin. Absorbable sutures are more commonly used in the superficial tissues. Occasionally, these absorbable sutures have a purple hue to them that can be seen through the skin. However, over approximately six to eight weeks, the sutures should absorb and the color should go away. Rarely, some surgeons will put some permanent sutures on the outside of the skin, but these are removed after 5 to 7 days. You should discuss this with your surgeon if you have questions about what type of sutures they used.
I hope this is helpful.
David Shafer, MD
Shafer Plastic Surgery
New York City
Go for the scar revision.
It is very unusual to use permanent sutures directly under the skin along the incision (scar)line, but it sounds like that's what you've got. The sutures seem to be causing you irritation, as well. You should probably check with your surgeon to find out what type of sutures are in place. If they are permanent, then you should have the entire scar excised along with the sutures. Good luck.
When Knots are Not Appropriate
Abdominoplasty or Tummy Tuck typically involves the tightening of the rectus abdominis muscles, which become separated or splayed apart and weakened by pregnancy. Usually, the muscle repair is done using permanent (non-absorbable, i.e. not dissolved by your body) sutures, which may be made of monofilament nylon, polypropylene, or braided polyester.
The muscle repair technique can involve a single, running layer of suture; alternatively, it may involve multiple "interrupted" sutures; or the repair may include a combination of interrupted single sutures reinforced with a running suture.
Whichever technique is used, it is important for the surgeon to "bury" the knots of the sutures, whereby the knots are tied so as to tuck under the tissue (think of tying your shoes with the knot and loops tucked under the shoelaces). This is particularly important when the stiffer nylon or polypropylene sutures are used in a very thin patient with minimal abdominal fat.
"Permanant" or non-absorbable sutures are also sometimes used to close the skin incisions and to repair the umbilicus, but these sutures are typically removed by your surgeon within two weeks after surgery. Ideally, sutures should not be seen or felt, but should only do the job for which they are intended and only for as long as they are needed.
Permanent sutures are used inside to hold the muscle in place
Normally, permanent sutures are only used inside to hold the muscle in place. Generally, skin sutures are dissolveable. Though some doctors will apply permanent skin sutures that will be removed ten days to two weeks after surgery. Most doctors now use the newer dissolvable sutures that are quite strong that will dissolve in about three months.
Permanent sutures are common but they should not be visible.
You must be thin. What can happen is: permanent deep stitches are used to bring the rectus muscles together, and if you have very little fat covering the muscles, then the stitches can be felt and even seen.
There is no easy solution for this. If it isn't too bad, I would live with it. Otherwise, the sutures have to be removed which is essentially another tummy tuck.
Tummy tuck and sutures
Some surgeons use permanent as well as absorbable suturs for a tummy tuck. For the tightening of the abdominal fascia I usually use a permanent non-absorbable suture. For the skin and subcutaneous tissue, I usually use absorbable sutures. But, like any chef, we all do it differently.