The Four Basic Steps in Plastic Surgery- #4

Ice golf anyone! "Chilly Open" on Lake Minnetonka.

Step 4: Wound Closure.

The final step is suturing (sewing) the skin and deeper tissues back together, also known as wound closure or tissue approximation.   How well this is done will determine the physical appearance of the scar.   Underlying tissues (muscle, fat, breast tissue) must be brought back together beneath the skin. If not, the scar will look depressed or puckered when compared to the surrounding skin.   The underlying fat, muscle, and/or breast tissue must support the skin at the proper level.   In the most extreme instances, the skin can actually heal to the underlying muscle resulting in a severely depressed scar that moves unnaturally with muscle contraction.

Please check back next time: Lisa’s Rhinoplasty surgery (nose job) blog.

The skin edges must also be brought back into alignment.  Ideally, the dry outer layer of the epidermis (skin) on each side of the incision should line up perfectly. If done correctly, skin cells will seal this type of incision within 48 hours.   Early epithelialization (healing) will reduce the risk of infection and give a thinner scar.

Absorbable and dissolving stitches have been available for twenty or more years.   I use these sutures exclusively for would closure, therefore virtually eliminating any need for suture or staple removal.   Stitches are either absorbed by the body or wash out over time.   This technique requires a little more time of my time in the operating room, but I think it yields a superior result.

Where possible, skin glue (Indermal, Dermabond) is applied to incisions, effectively sealing them from external contamination, thus making wound care easy.  Following surgery, I direct my patients to simply wash the wound gently in the shower and then immediately dry it lightly.   Only minimal dressings are used for the first 12 to 24 hours on occasional procedures.   Research suggests that skin glues reduce the risk of infection and often yield less noticeable scars.   This has certainly been the case for my practice.

Please check back next time:  Lisa’s Rhinoplasty surgery (nose job) blog.

3 Responses to “The Four Basic Steps in Plastic Surgery- #4”

  1. annie Says:

    Does anyone know if Nip N Tuck is finished in america? How many seasons are there of Nip N Tuck or are they still making them.

    If it is the last season in the states. How many seasons were made.


  2. annie Says:

    Can someone please help me with a nip n tuck question.

  3. nipntuck Says:

    The nipntuck cosmetic surgery practice and the Nipntuck Group are alive and well.
    You might be confusing us with the Nip/Tuck television series. I just do not know if it is continuing. I hope it is. Your question can be answered at Thanks for the comment and your interest in the Nipntuckblog!



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