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As I matured as a surgeon that things change, you know, everyone is in the process of re-evaluating their own work and over the past 20 years, doing scar, revisions and surgeries are require a cut on the skin especially in areas of high sensitivity like in the middle of the face where scars are making me revisit and think about things. And so initially I was a big fan of doing shorter epidermal and longer dermal sutures. The shorter epidermal suture I did because I didn’t want to have track marks are visible cuts on the skin or having issues with sutures irritating the skin on the surface. I also did not want to have visible sutures that were there for too long because patients will be irritated to see visible sutures. At the same time, I use very long dermal sutures, deep buried dermal suture that’s below the skin. Because I wanted that not to have the skin separate and that’s the reason I would leave those buried deep dissolvable sutures for very long. In 2015, I was lecturing in Russia and they were talking about using something called 7o vicryl, which is a really tiny hair suture used for closing rhinoplasty stitches or rhinoplasty incisions and it really, really changed everything for me. I started to see my results so much better. The reason is that I believe several reasons one, is the sutures are there for a long, long time and so that the epidermis does not have a chance to stretch back because the biggest offense or the biggest problem was guard visions is epidermal stretch back. Where the epidermis the outer layer stretches back. The other thing that was amazing and fascinating is that in the old days when I had to use nylon in a rhinoplasty I would put in maybe three or four sutures because they were so painful to remove. Now I under magnification of, I find something, I don’t like with the incision, I’ll put in 30 sutures because they don’t have to be removed and because they are white colored and really tiny like a hair, they’re not very visible. And I found that even when African-Americans because they’re so thin and tiny that even if they’re there for a few weeks, it’s not an issue. They don’t leave track marks. Although theoretically that’s possible track marks, being the suture, visibility invite the marks of the sutures leave behind, but they really minimize the risk of stretch back. By the flip side, I’ve been using much shorter dermal sutures. I used to use PDS or polydioxanone sutures that last like six to 12 months to hold the deeper tissues together. What I found out was unnecessary, and the second thing I found was when I use them, they could spit and when they spit, they opened the wound up and they cause separation. I now use for the most part monarchical, which is a much shorting shorter acting suture, between two to four months and that leads to less spitting. And I use much, many fewer of those sutures are used to use quite a few sutures. So, I’m now reversing it with the longer epidermis and I do that for now for everything. Now I’ve done upper blepharoplasties, facelifts, scar revisions. I just did a blepharoplasty, earlobe repair for a gentleman that had a bad blepharoplasty and facelift done elsewhere. With these types of sutures and I know he’s going to heal exceptionally well. This is just maybe a subtle distinction of how I’ve changed over the last five to ten years and why I think this is something may be important in case especially if you’re coming to me for any kind of surgery, you may wonder why I’m using dissolvable sutures. What is the point? It is because of laziness and actually it’s nice, my staff doesn’t have to take out the sutures. It’s also nice for my out-of-town patients. A lot of patients that come in for a mini facelift or facelift if there’s not too much swelling I can take the drains out the next day, they can often times leave the next day. They’re no more sutures to remove on rhinoplasties and facelifts and everything on lip reductions. All those things are dissolvable sutures, so I don’t to remove anything anymore. So that’s also a nice bonus for my patients.

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