Facial Suture Management
Facial sutures must be removed at 3-5 days post-placement to optimize cosmetic outcomes and prevent permanent scarring. 1
Timing is Critical for Facial Wounds
The face requires the earliest suture removal of any body location due to its excellent vascular supply that accelerates healing and the paramount importance of minimizing visible scarring in this cosmetically sensitive area. 1
Key timing guidelines:
- Remove facial sutures at 3-5 days (not earlier, not later) 1
- This contrasts sharply with other body areas: scalp/trunk require 7-10 days, extremities need 10-14 days 1
- The 3-day minimum prevents wound dehiscence and widened scars, particularly in areas of facial movement 1
- The 5-day maximum is absolute—delayed removal beyond this increases risk of permanent suture marks, tissue reaction, and infection 1
Suture Material Selection
For facial wounds, use 5-0 or 6-0 monofilament non-absorbable sutures for skin closure. 2 These provide optimal handling, secure knots, and minimal tissue inflammation. 3, 4
However, strongly consider absorbable sutures (5-0 coated irradiated polyglactin 910 or 5-0 poliglecaprone 25) to eliminate removal entirely, particularly in pediatric patients but applicable to all age groups where cosmetic outcomes are paramount. 1, 5 A well-designed study of 41 facial wound closures demonstrated no difference in long-term cosmetic results between absorbable and non-absorbable sutures at 6 months, with the advantage of avoiding removal-related anxiety and discomfort. 5
Suturing Technique Essentials
Proper technique is as important as timing for optimal cosmetic results:
- Achieve good eversion of skin edges to prevent depressed scars 3
- Use deep dermal sutures (4-0 or 5-0 absorbable) to reduce tension on the superficial closure 6
- Place superficial sutures with minimal tension to avoid suture marks 3
- Ensure precise edge approximation and uniform tensile strength along the wound 3
For complex facial reconstructions near free margins (eyelids, lips) or cosmetic unit junctions, suspension sutures to stable structures (orbital rim, zygomatic arch) prevent distortion from wound contraction and maintain natural facial contours. 7
Pre-Removal Assessment
Before removing sutures at 3-5 days, verify:
- Adequate wound edge approximation without gaps 1
- No signs of infection (erythema, purulence, warmth) 1
- Patient factors (advanced age, diabetes, immunosuppression) may warrant extending to day 5 rather than day 3, but never beyond 5 days 1
Post-Removal Care
After facial suture removal:
- Apply Steri-Strips for additional support if any tension remains across the wound 1
- Keep the area clean and dry 1
- Monitor for wound separation in the first 24-48 hours post-removal 1
Note that adding adhesive strips to wounds closed with buried dermal sutures does not improve cosmetic outcomes or reduce scar width, though they provide reassurance if tension concerns exist. 8
Alternative Closure Methods
For low-tension facial wounds, tissue adhesives provide painless closure without requiring removal. 1 However, sutures are significantly better than tissue adhesives for minimizing dehiscence (RR 3.35,95% CI 1.53-7.33), with tissue adhesives showing a 3-fold increased risk of wound breakdown. 8
Critical Pitfalls to Avoid
The most devastating error is leaving facial sutures beyond 5 days, which significantly increases permanent scarring in this cosmetically critical area. 1 Conversely, removing before 3 days risks dehiscence, widened scars, and complications in areas of facial movement. 1
Do not assume small amounts of wound oozing will resolve spontaneously—address any leakage immediately. 8