Permanent Interrupted Suture Placement in Blepharoplasty
Place two permanent interrupted 6-0 polypropylene (Prolene) sutures at the medial and lateral ends of the blepharoplasty incision, incorporating the dermis and orbicularis oculi muscle, followed by a running fast-absorbing gut suture for the remainder of the closure. 1
Optimal Suture Technique and Layers
Two Permanent Interrupted Sutures
Position the two 6-0 polypropylene (Prolene) interrupted sutures at the medial and lateral extremes of the incision where standing cone deformities are most likely to develop and where precise approximation is critical for preventing dog-ears. 1
Include both the dermal layer and the underlying orbicularis oculi muscle in each interrupted suture bite to provide structural support and prevent wound separation under the dynamic tension of eyelid movement. 1, 2
These permanent sutures must be removed at 3-5 days post-operatively to prevent suture track marks and tissue reaction in this cosmetically critical facial area. 3
Completing the Closure
After placing the two permanent interrupted sutures at the ends, close the remainder of the incision with a running 6-0 fast-absorbing gut suture in a subcuticular fashion, which eliminates the need for removal and minimizes milia formation (2% incidence versus 17% with locked cutaneous Prolene). 1
Avoid running subcuticular Prolene for the entire closure, as this technique results in higher rates of standing cone deformities (5.5%) and milia (2.5%) compared to the hybrid approach. 1
Layer-Specific Considerations
Dermal Layer
- The dermal bites should capture adequate tissue depth (approximately 2-3mm from the wound edge) to ensure tension-free approximation without strangulation of tissue. 1
Orbicularis Oculi Muscle
Include the orbicularis muscle in the permanent interrupted sutures to provide structural support, particularly at the lateral and medial canthal regions where muscle reattachment prevents contour irregularities. 2
The muscle layer provides the primary tensile strength during the critical first week of healing when sutures retain 50-75% of their original strength. 4
Critical Timing for Suture Removal
Remove the two permanent polypropylene sutures at 3-5 days post-operatively, as facial sutures require the earliest removal of any body location due to excellent vascular supply and the paramount importance of minimizing visible scarring. 3
Leaving facial sutures beyond 5 days significantly increases the risk of permanent suture marks, tissue reaction, and infection in this cosmetically sensitive area. 3
The fast-absorbing gut suture requires no removal and will dissolve within 5-7 days, eliminating patient anxiety and additional visits. 1
Common Pitfalls to Avoid
Never use running locked cutaneous Prolene for the entire blepharoplasty closure, as this results in a 17% milia rate and visible suture tracks. 1
Do not use plain gut suture (as opposed to fast-absorbing gut), which causes unsightly scarring in 2.8% of cases and higher milia rates (6.7%). 1
Avoid placing all sutures superficially in the dermis alone without incorporating the orbicularis muscle at the critical medial and lateral points, as this leads to standing cone deformities requiring revision. 1
Never assume permanent sutures can remain beyond 5 days on the face—this is the single most critical error leading to poor cosmetic outcomes. 3