Why I use Dissolvable Epidermal Sutures Now
In the past, I was convinced that I needed to have very short lasting epidermal (outer skin) sutures and long-lasting dermal (deep, below the skin) sutures. I am now convinced of the exact opposite. In the past, I would use deep, dissolvable stitches that would take 6 to 8 months to dissolve in order to minimize the skin from stretching back and causing the wound to stretch. I have unfortunately seen some of these stitches spit out and thereby make the wound separate more. I have used shorter-acting dissolvable stitches and have seen a great improvement in my wound results. Conversely, I was convinced that I needed to use short-acting stitches that were non-reactive (monofilaments) that I would remove at a week after a procedure. I now also use dissolvable stitches on the skin that take 2 to 3 weeks to completely dissolve. In other words, I no longer take out stitches in many cases. I have found that the longer these stitches stay in the less that the wound wants to separate. A great fear of many individuals is that these stitches may leave track marks behind. I have not seen this outcome with the very tiny dissolvable skin stitches that I use. Another fear is that these outer skin stitches will be very noticeable to an onlooker. Although, yes, they are there, these stitches tend to be very very small and flesh colored, so most people don’t complain of this problem. They are willing to trade a very good result for a minor inconvenience. A bonus is that there is no need to remove stitches. They even hide well in African-American skin because the stitches are so small. Do I use this technique for all areas of the face and neck? No, for eyelids, I still use a monofilament that I remove at a week because I find this to heal the best. Same thing goes for the front of the ear for a facelift. Those stitches come out a week. For behind the ear in an otoplasty or as part of a facelift, I use stitches that take about 2 weeks to dissolve and are different from the ones I described above. I typically use the above-described stitches for areas like rhinoplasty, mole removals, scar revisions, and below the chin during chin implants or facelifts. It is perhaps too difficult to elaborate on why and how I use every stitch that I use but I wanted to share with you some fundamental shifts in my perspective over the years.