title: Improved upper blepharoplasty outcome using an internal intradermal suture technique: a prospective randomized study.
abstract: OBJECTIVE
  To assess whether a suture technique in upper blepharoplasty may be the cause of differences in the occurrence of suture abscess formation and focal inflammation.
  
  
  METHODS
  A Level I, randomized controlled trial. The upper blepharoplasty wound was closed with a running intradermal suture. External intradermal suturing implied that this suture was started by initially passing it through the intact skin adjacent to the wound. In contrast, internal intradermal suturing meant the intradermal suture was not started in the adjacent skin but simply within the wound itself. One week and 6 weeks after surgery, the presence of suture abscesses and focal inflammation was assessed at the entrance and exit of the sutures.
  
  
  RESULTS
  After 1 week, 12 abscesses (40.0%) were found at the medial side of the externally sutured upper eyelids and 4 abscesses (13.3%) in the internally sutured upper eyelids (p = .02). The presence of erythema and edema after 1 week was also significantly lower in internally sutured upper eyelids (p = .02).
  
  
  CONCLUSIONS
  In this series, the method of starting the suture (internal vs external) at the medial side of an upper blepharoplasty wound was associated with a statistically significant reduction in the incidence of medial wound inflammation and suture abscess formation at a 1-week follow-up.
authors.affiliation: *Department of Plastic Surgery, University Medical Center Groningen, the Netherlands; †Department of Plastic Surgery, Medical Center Leeuwarden, the Netherlands; ‡Private Clinic for Aesthetic Surgery, Bergman Clinics Heerenveen, the Netherlands.
authors.forename: Shariselle M W
authors.initials: SM
authors.lastname: Pool
authors.forename: Irene S
authors.initials: IS
authors.lastname: Krabbe-Timmerman
authors.forename: Michel
authors.initials: M
authors.lastname: Cromheecke
authors.forename: Berend
authors.initials: B
authors.lastname: van der Lei
mesh_terms: D000038:Abscess / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D004487:Edema / Q000209:etiology / Q000517:prevention & control; D004890:Erythema / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D014945:Wound Healing