Cosmetic plastic surgery sutures to hold you together
As a cosmetic plastic surgeon I spend a great deal of my life placing plastic surgery stitches / sutures in patients as part of their cosmetic surgery. Though some stitches stay deep in the skin and are never removed or simply dissolve away, most have to be removed by the plastic surgeon or their nurse at some point. But when?
Types of sutures/stitches
Types of sutures
Sutures can be divided into absorbable and permanent sutures.
These are sutures that are designed to be dissolved by the body. Different types of sutures have different rates of dissolution, and during this time will lose strength at a predictable rate. These sutures are typically made of organic materials that the body can destroy. Often, these stitches are placed under skin and will dissolve with time. They are placed in locations where long-term/permanent strength is not needed and where natural scar tissue that forms in wounds can take over the function of sutures. Our bodies actually have to mount an inflammatory reaction to dissolve these sutures. They do not self-destruct like in Mission Impossible. Some sutures I use in cosmetic plastic surgery include:
- Catgut – actually made from sheep intestine these days; absorb quickly and not very strong
- Chromic catgut – catgut sutures that are treated with Chromium to increase their durability
- Silk – a very long-lasting absorbable suture
- Vicryl – a polysaccharide suture lasting about three months
- PDS or Monocryl – another cross linked polysaccharide that lasts a long time
These are stitches that will not be dissolved by the body. They either stay in place forever or have to be removed by a cosmetic plastic surgeon. The advantages of these sutures are:
- greater tensile strength – stronger
- less reactivity – less inflammation and soreness
- Easier removal – tissue does not integrate with them
Some plastic surgery permanent sutures include:
- Metal wire
Thickness of sutures
All stitches are manufactured in different diameters and with different types of needles.
The numbering system for sutures can seem a bit complicated: 2, 1, 0, 2-0, 3-0, 4-0, 5-0, etc.
The thickest sutures have a numbering system that seems logical. The higher the number, the thicker the suture. A #2 suture is stronger than a #1, which is stronger than a #0.
Sutures smaller than #0 are identified by having “-0” at the end. The thinner a suture, the larger the number! So, a 3-0 suture is thicker than a 6-0, and so on.
When to use which suture thickness
Your cosmetic plastic surgeon will know which sutures to use where based on his or her experience and training. I still change the sutures I use for different procedures based on experience, quality of my surgical results and pragmatic reasons.
A #1 suture is a thick suture used to keep the abdominal muscles together after an abdominoplasty.
A 4-0 suture is about the thickness of a typical thread used to sew a button. It is used for cuts on a hand or leg that need more strength.
A 6-0 suture is as thin as a hair and used for delicate closures of skin cuts on the face.
A 10-0 suture is used in microsurgery operations.
A 6-0 nylon suture is as strong as a 4-0 catgut! Your plastic surgeon knows…
When should sutures be removed from skin?
It depends on what the suture is doing! In the skin of the face where there is little tension on the skin, the sutures may be removed in 5-7 days. In areas where there is movement and tension, such as the arms and legs, sutures may need to be kept for up to a month. Your cosmetic plastic surgeon will have a plan and decide when to take the stitches out. What is the downside of leaving them in too long? Scarring and difficulty removing them later!
This information presented on sutures is intended to give you a general idea about what they are and how cosmetic plastic surgeons use them. Do not start telling your surgeon what type of suture to use—your plastic surgeon knows better than you!