Sutures Make Differences in Complications, Revision of Blepharoplasties

Among the individuals whose surgery was closed with 5-0 running, locking polyprolene, 8 patients (17%) developed milia; 2 patients (4.4%) had standing cone deformities; no patient had scarring; 1 patients (2.2%) had erythema; none of the patients had suture marks; and minor hematoma was absent.

Among the persons whose surgery was closed with 6-0 running plain gut, 12 patients (6.7%) developed milia; none had standing cone deformities; 5 patients (2.8%) had scarring; 16 patients (9%) had erythema; 3 patients (1.6%) had suture marks; and minor hematoma occurred in 1 patient (0.5%).

Of the patients whose surgery was closed with 6-0 fast-absorbing gut, 2-0 simple interrupted 5-0 polyprolene, 9 (2%) developed milia; none had standing cone deformities; 1 patient (0.2%) had scarring; 10 patients (2.1%) had erythema; 2 patients (0.4%) had suture marks; and minor hematoma occurred in 2 patients (0.4%).

None of the patients in any of the groups developed a major hematoma, infection, or dehiscence, Dr. Joshi said.

Interpretation of the Data

We found that there were significant [p < 0.05] differences between materials used in the development of milia, persistent scarring, and erythema. The results that saw erythema associated with plain gut were similar to our clinical experience. We found that the erythema was enhanced by the use of Neosporin use postoperatively in these patients. We now tell our patients not to use Neosporin postoperatively.

This is a large series of more than 800 patients who underwent upper lid blepharoplasty. We found significant differences between sutures. The study was performed by the same author using similar technique to try to minimize variations in terms of techniques, Dr. Joshi said.

Milia and standing cone deformity were the most common complications of upper lid blepharoplasty, he said in discussing the study. Subcuticular Prolene and running fast-absorbing gut resulted in nearly equal rates of milia, and the lowest of the four groups. Standing cone deformity rates were highest with subcuticular Prolene and running locking Prolene. Erythema and scarring appear to be associated with plain gut sutures versus the other sutures.

Dr. Joshi said that the study results are not expected to change general clinical practice. We don’t expect that facial plastic surgeons or surgeons who perform these aesthetic procedures are going to change their material or technique. We just offer this as a topic for consideration for further studies. Whether we can apply these results to other areas of the face remains to be seen, he said. He noted that one of the confounding factors in the study is that the primary author was able to classify groups into whatever type of closure they should get; additionally, scarring could have been affected by the method of fat excision used by the investigator.