Skin Contour Sutures in Rhinoplasty

Overview

The skin and soft tissue covering is a critical part of the rhinoplasty result. The authors describe skin contour sutures, external stitches used to hold the lifted skin flap against the underlying nasal skeleton, based on the principle that suture pressure brings the two together. The study assessed how effective those sutures are at approximating the nasal skin.

Sections of note

• Two study groups; the first was 459 consecutive rhinoplasty cases between December 2016 and April 2022, reviewed retrospectively.
• Average follow up in that group was 41 months, range 12 to 64 months.
• Any visible suture mark after the sutures were removed disappeared completely within 6 weeks in most patients.
• No complications were reported in the first group.
• The second group was 30 patients with thick skin who had the sutures placed, with ultrasound assessment before and after surgery.
• Ultrasound data indicated the covering healed faster, returning to its original thickness earlier when the sutures were used.
• The authors state the sutures appear to decrease severe swelling, blood collections, loss of tip definition, scarring and polly beak deformity.

What it means for a patient

• The sutures are placed through the skin from outside and removed later, leaving marks that faded within six weeks in most patients.
• The measured benefit is faster return of the covering to its normal thickness in thick skinned patients.
• The wider claims about swelling, blood collections and deformity are stated as appearances rather than measured results.
• Neither group had a comparison arm without the sutures, so the claimed benefits are not demonstrated against a control.

Why this paper matters

How the lifted skin settles back onto the reshaped framework determines much of the final contour, and thick skinned patients are where that fails most visibly. This study proposes a simple external measure and supports it with ultrasound. Without a control group its main claims remain unproven.

Terms

• Skin soft tissue envelope: the skin, fat and muscle covering the nasal framework.
• Skin contour suture: an external stitch pressing the skin onto the framework beneath.
• Approximation: bringing two tissue layers into contact so they heal together.
• Polly beak deformity: a fullness above the tip giving the profile a beak like outline.
• Fibrosis: the formation of thickened scar tissue.
• Hematoma: a collection of blood under the skin.