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dissolvable stitches

Dr. Naderi answers your questions about all facial plastic surgery procedures, from facelift, rhinoplasty (nose job), to eyelid surgery (blepharoplasty), and dermal fillers.

dissolvable stitches

Postby redhead25 » Fri Jun 26, 2009 11:23 am

Hello, Dr. Naderi.

I am two days out from an open revision rhino/septo. I am feeing good, and my doctor was very pleased at my first follow up yesterday.

My question is regarding my dissolvable stitches placed over the open incision (across columella). I was surprised to learn that my doctor used dissolvable stitches for this area, and he said that they would just dissolve on their own. I am curious about what benefit/down fall there is to using dissolvable stitches across the columella.

Do you ever use dissolvable stitches in this area in your practice? If so, when do you make this choice? If not, do you think I may encounter any adverse affects from dissolvable stitches in the long run in terms of scarring?

I am currently using an antibiotic ointment from my doctor on the incision line to keep it moist. I apply it about four times a day using a q-tip, as directed by my doctor.

Thank you for your time and your help.

Red
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Postby Dr_Naderi » Mon Jun 29, 2009 3:16 pm

Hi Red,

I know that you and I spoke a lot about noses a few years back. Sounds like you took the plunge and did the surgery. Congrats.

As far as sutures for the columella:

No decent rhinoplasty surgeon would ever use dissolvable sutures there. 7.0 nylon is the best. Dissolvable sutures are too inflammatory and can leave marks.

Now if he used it, it is still not too late. He should remove them on post op day 3,4 or 5 so that they dont leave marks. BUT that depends on his closure technique. If he closed things in one layer with tension, the removing them early can pop the incision open and that way worse than leaving them in longer.

I hope he at least used a 6.0 mild chromic suture or a 6.0 Fast Absorbing Gut.

Again, I dont want to second guess someone else's work and I am sure he must be a great surgeon since you did so much research for so many years but most rhinoplasty surgeons prefer very fine non-absorbable sutures.
www.VirginiaFacialPlasticSurgery.com

www.VirginiaRhinoplasty.com

www.RhinoplastySpecialistSurgeon.com


[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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Postby redhead25 » Mon Jun 29, 2009 4:59 pm

I have an appointment tomorrow morning, and I'll ask him about this.

Tomorrow will mark six days with the dissolvable stitches, so I guess I'm screwed? I've kept the area very clean, and it seems good for now, but is there nothing that I can do at this point?

So it will definitely scar? Wow. What a trade off: great result otherwise with tons of work to revise a primary... with a scar? I'm surprised that he would make such a "bad" choice after being able to fix such a tricky area.

Any advice on how I should approach this subject?

Thank you.
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Postby Dr_Naderi » Mon Jun 29, 2009 6:29 pm

I think you misunderstood me a little:

Once you get the columellar incision you definitely will have a scar no matter what suture is used. But the vast majority of patients' scars are nearly invisible due to the nature of the skin there. Techniques that make the scar even less noticeable are using 7.0 (thin) sutures and using Nylon or Prolene (non absorbable) sutures and removing them early.

Now, that does not mean you will have a bad scar. You may have a very acceptable scar regardless. I would not be too worried at this point. Whats done is done.

In certain areas of the face, use of absorbable sutures are actually advisable but the vast majority of surgeons (and almost every rhinoplasty specialist that I know) use Nylon to close that incision. But again, just using absorbable sutures does not mean you are screwed or you will have a bad scar.

No reason to "approach" anything yet. Let it heal. If 3 months down the line the scar is not acceptable then you can raise his decision to use absorbable sutures as a potential cause. No need to panic yet.
www.VirginiaFacialPlasticSurgery.com

www.VirginiaRhinoplasty.com

www.RhinoplastySpecialistSurgeon.com


[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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Postby redhead25 » Mon Sep 07, 2009 1:56 pm

Hi, Dr. Naderi.

Just wanted to give you an update. It's been a little over two months since my revision with the dissolvable sutures over the open columellar incision, and my incision line is just about invisible already!

My nose is exactly how I imagined it would be in the first place, and I couldn't be happier.

Thank you for all of your information, but you may want to be a little cautious when you say things about what "decent" rhinoplasty surgeons would or would not do. You really worried me, and as it turns out, it wasn't necessary.

That being said, I still think that you are a fantastic person and a great doctor, and your advice to everyone on this board is endlessly helpful. It's so great to be able to get help from someone like yourself, and this type of communication allows for you to really influence thoughts and decisions by many people.

I am off to enjoy my nose, and I wish you all the best,

Always a big fan,
Red :-)
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Postby Dr_Naderi » Thu Sep 10, 2009 4:34 pm

Hi Red,

Im glad you are doing well.

I also hope you had initially read my entire post where I also wrote:

Again, I dont want to second guess someone else's work and I am sure he must be a great surgeon since you did so much research for so many years but most rhinoplasty surgeons prefer very fine non-absorbable sutures.


I still stand by my first comment that "standard of care" in plastic surgery is the use of very fine non-absorbable sutures on the columella. There is no doubt or dispute about that. I am just glad your nose surgery went as you had hoped and planned.

Kindest regards,


S.N.
www.VirginiaFacialPlasticSurgery.com

www.VirginiaRhinoplasty.com

www.RhinoplastySpecialistSurgeon.com


[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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