I had an arm lift a month ago. Plastic surgeon said my body was pushing the dissolvable stitches out. Is this normal? (Photo)

Question

2 wks ago I had areas to open up and drain. Plastic surgeon dug into each opening with tweezers and started yanking them out leaving the openings much bigger. Mind you..he has done this 4 times already in 2 wks. He used silver nitrate in the open areas & said to cover with gauze at all times. Is this normal??

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about post-operative healing after an arm lift or brachioplasty.  What you are describing is not “normal”, but is not uncommon.  After an arm lift or brachioplasty, buildup of fluid (seroma) or blood (hematoma) can happen.  Sometimes the fluid accumulation is too much and causes pressure on the incision.  Too much pressure causes the incision to open and fluid to drain.  The non-functioning, hanging sutures need to be removed so that the sutures will not become infected.  
  
It appears that your plastic surgeon is doing all the right things.  I would suggest following his or her advice.  Rest assured, these arms wounds will heal.  They just need time to heal from the bottom of the wound upward.  If you have any other questions regarding post-operative healing from an arm lift or brachioplasty, please contact my office.  Sincerely, Dr. J. Timothy Katzen

Orna Fisher, MD · Answer

What happened to you is not that uncommon. Even though certain suture material is dissolvable, not everybody's body processes it the same way. In some people like yourself, the body perceives it as a foreign object and "spits it out".  The area where the suture is coming out gets inflamed and can form a small area of infection, this is known as a suture abscess.  The only thing to do is local wound care until it heals. If you are unhappy with the scar later, you can have a scar revision which would entail using a different type of suture than the one your body did not react well to.  If you do opt for this, I recommend waiting at least six months to a year before having the scar revision.  Not everyone needs a scar revision. Oftentimes the scars look just fine or I can be helped with a laser treatment.

Stefan Mark Szczerba, MD · Answer

It happens for sure!  I think all surgeons struggle as to which sutures "spit" out of the wound the least.  I certainly have tailored by my sutures options over the years.  Eventually these areas will heal fine and a scar revision may be necessary after the scar matures.  Best Wishes!!

Aldo Guerra, MD · Answer

You have small wounds and this could have been started by your body "spitting out" the internal sutures. This is pretty common, especially with long incisions. At this point, good wound care and appropriate follow up with your plastic surgeon is the best approach.

Harry T. Haramis, MD, FACS · Answer

It is not uncommon for some deep sutures to come to the surface as they dissolve. Local wound care usually allows these to heal over several weeks to months.Close follow up with your plastic surgeon is recommended during this time.

Patricia Yugueros, MD · Answer

It is a very common problem, some patient developed small suture abscesses, that when the wound opens up, drains small amounts of purulent material, fortunately it heals once it drains and eventually looks good. Very few patients will require scar revision after a suture abscess. Keep the area dry and clean, and follow-up with your surgeon. It's going to take few weeks to heal. Good luck.

Saul R. Berger, MD · Answer

It is customary to close these incisions with a layered approach, meaning that there are individually placed stitches at the deep part of the skin and the layer just underneath the skin.  When these sutures are tied, they form small, firm knots that may end up pushing upward toward the skin and push through before sufficient time has passed to allow them to dissolve.  This phenomenon is particularly seen in areas of very thin skin, such as the skin of the arm.  Treating these areas with topical care and following up with your surgeon are both appropriate to achieve complete healing.
Dr. Saul Berger, Los Angeles, CA

Donald W. Hause, MD · Answer

Unfortunately this can happen with any type of dissolvable suture. Keep the areas clean and they should heal in a few weeks. In 6 months or so a scar revision can be done if necessary, but many times it is not. All surgeons see these awful problems but, thankfully, they are self-limited and don't severely impact the final result. Best of luck.

Andrea Van Pelt, MD · Answer

Even with the best surgical technique and sutures, this can still happen.  You may have had some tiny pockets of infection around the sutures, or small collections of fluid as part of the healing.  When this occurs, sometimes you body tries to fix the problem on its own by "spitting" out the sutures and opening up the incision.  Also, the skin on the inner part of the arms is fairly thin and sutures don't have as much deep, thick dermis to grab onto.  The best thing to do is wait and let the open areas heal on their own.  Wounds heal best if they are kept moist.  After the skin closes in, if the scar isn't optimal, then your surgeon will be able to do a minor scar revision with just local anesthetic.  Try not to worry!

Anthony J. Taglienti, MD · Answer

Thank you for your question. I am sorry to hear that you are going through this, but, unfortunately, this can sometimes happen with an arm lift. I would continue to monitor the areas, and to listen to your Plastic Surgeon. The wounds will heal in  - it may just take some time. If you can, increase your protein intake as this can facilitate healing. You will likely have slightly widened scars in the areas that are open, but these can be revised at a later date. Hang in there!

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