Domal suturing with permanent sutures
The bottom line is that the sutures are not necessary after about 6-8 weeks. The underlying scar tissue typically is what is needed to maintain the new tip position. While it is possible that permanent sutures can work their way out over time, typically they do not and are not an issue for patients.
Sutures Used For Tip Refinement
I agree with y colleagues that the type of suture is used is far less important than the techniques used to shape the tip. I prefer 5-0 nylon monofilament suture, but many of my respected colleagues and mentors use absorbable sutures. The domal areas are probably dependent on suture strength for about 2 weeks. There is far more to the complexity of Rhinoplasty than this detail.
Sutures and nasal dome shape
The sutures are not needed for shape after about 6 weeks which is why most surgeons use absorbably material when they shape the nasal cartilages. If your nylon sutures ever cause a problem (poking through the skin; infections) they will need to come out.
Dome Suturing Technique
The type of suture used during nasal tip surgery is not as important as the execution of the actual dome suturing technique during the operation. I have seen all kinds of material used during cartilage suturing (some permanent, some absorbable) and long term results are comparable for both. The majority of surgeons however use permanent material because its concealable and lasts longer, obviously. The cartilage is reshaped with the suture and it is the reshaping process through suturing that gives the rhinoplasty permanence.
This is a hotly debated topic and was recently discussed at the Rhinoplasty Symposium at the American Society of Aesthetic Plastic Surgery annual meeting. The short answer is that permanent or absorable suture can be used and does not really make a difference in terms of the outcome that can be achieve. HOWEVER, permanent suture is permanent and can lead to wound healing problems or infection, suture abscesses and other issues which is why many surgeons no longer use permanent sutures. A consultation with a board certified plastic surgeon can help answer this question. Best of luck, MMT
I use, and the surgeons I know use, permanent sutures for our tip reshaping sutures. They too do lose strength, but over the years rather than months. I feel this provides a more stable platform for all scar that forms to be fully mature to aid in the support of the new shape along with the support of the suture.
Scar tissue holds your results
Although some surgeons choose to use permanent sutures in rhinoplasty, your results are held together by scar. The key is to stabilize the structures for a long enough time to give the scar a chance to mature and strengthen.