Permanent and Visible Sutures for Tummy Tuck: Normal?

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.

Hello EliseC,

Thank you for your question regarding the use of sutures in tummy tuck surgery. Typically, plastic surgeons use permanent sutures for the muscle plication portion of the procedure. These sutures are placed internally to tighten and reshape the abdominal muscles. However, for the tummy tuck incision, dissolvable sutures are commonly used. These sutures are not visible externally over time as they dissolve on their own. Therefore, it is normal for patients not to see visible sutures along the tummy tuck incision as they heal.

If you have any further questions or concerns, feel free to ask.

Best regards,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

The sutures in muscle repair are permanent sutures. You will not see or feel them. The deep fascia of the skin, the lower layer of the skin (DERMIS) and the skin are all closed with absorbable sutures.

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.

Both permanent and absorbable sutures are used in most abdominoplasty procedures.  Permanent (but not visible) sutures are often used to tighten the muscles.  It is variable what type of suture is used on the skin.  If permanent sutures are used on the skin they are usually removed by one week.

A tummy tuck procedure utilizes both absorbable sutures for the suture line and non-absorbable sutures for the midline abdominal muscle tightening. The type of suture and more importantly, the method of suturing, is critical to acheiving excellent results.
One of the most crucial factors in the long term outcome depends on the sutures used to reapproximate a very important fascial layer known as Scarpa's fascia. If this is not performed, the incision may splay apart and become depressed.

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.

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

Usually, permanet or semi-permanent sutures are used to tighten muscles.  However, these sutures are NOT visible.  When we close skin, this is done with non-permanent, dissolvable sutures that are clear, again NOT visible.

Every Plastic surgeon has definitive opinions on this topic. since you asked, I will share mine with you.
In general, sutures in surgery can be divided into PERMANENT (Silk, Cotton, Prolene, Tevdek, Dacron, Ethibond etc etc) and DISSOLVING - either short lasting, or longer lasting (Gut, chromic gut, Vicryl, Monocryl, PDS etc).
We usually use dissolving sutures when we want things splinted for a short time together BUT are confident that the scar would COMPETENTLY hold things in place after wards. We use permanent sutures when we want to make sure certain things do not separate (Heart valves, vascular grafts, hernias, ports etc).
for this reason mOST surgeon repair the abdominal muscles with permanent sutures - to make sure they do not separate. As regards the transverse closure, some surgeons DO use permanent sutures in the deep SFS layer to assure a long lasting lift of the thighs and prevent scar widening - others use only dissolving sutures. I subscribe to the opinions voiced by Dr. Lockwood, the inventor of the High Lateral Tension Abdominoplasty and I use permanent sutures interspersed with long acting dissolving ones in the SFS layer. BUT - NONE OF THESE SUTURES are visible from the skin.
Dr. P. Aldea