Most people are concerned about the appearance of a scar following surgery or a deep wound closure. The hope is often that using dissolvable stitches will bypass the body’s natural healing process and result in a scar-free outcome. While these specialized sutures offer many benefits for wound closure, they do not eliminate the risk of scarring. Scarring is a biological reality of tissue repair, and the final result depends on many factors far beyond the material of the stitch itself.
The Role of Suture Material in Scarring
A scar forms whenever the skin’s deeper layer, the dermis, is injured, prompting the body to repair the wound with fibrous collagen tissue. This fundamental healing response is the primary determinant of a scar, not the type of thread used to hold the edges together. Choosing dissolvable stitches over non-dissolvable ones does not stop the body from creating a scar.
The cosmetic advantage of absorbable sutures relates to their placement. They are frequently used in subcuticular closure, where stitching is done just beneath the skin’s surface. This internal method avoids the characteristic “railroad track” marks left by external stitches that penetrate the outer skin layer.
Non-dissolvable sutures may be preferred for surface closure in highly visible areas, such as the face or neck. They allow the surgeon to maintain consistent, precise tension control on the outer skin edges. This meticulous control is sometimes considered superior for achieving the finest possible line, even though it requires a follow-up appointment for removal.
How Dissolvable Stitches Are Absorbed
Dissolvable sutures are engineered from materials the body’s internal environment can safely break down and eliminate over time. The most common synthetic absorbable stitches are made from polymers, such as polyglycolic acid or polydioxanone. These materials are chosen for their predictable and controlled breakdown profile inside the human body.
The primary mechanism for the breakdown of these synthetic sutures is hydrolysis. This chemical process involves water molecules, abundant in the body’s tissue, gradually penetrating the polymer chains. This action slowly cleaves the chemical bonds, causing the thread to lose tensile strength and disintegrate into smaller, absorbable fragments.
The speed of absorption is calibrated by the material’s composition and density. For example, a polyglycolic acid suture may fully absorb within 60 to 90 days, while a polydioxanone suture used for deeper support might take up to six months. This varying rate ensures the wound remains supported for the time needed for initial healing before the material is fully metabolized.
Key Factors Determining Final Scar Appearance
The appearance of a final scar is overwhelmingly influenced by factors related to wound physics, patient biology, and meticulous aftercare.
Wound Tension and Surgical Technique
The amount of tension on the wound is the most significant physical determinant of scar quality. Incisions located over joints or areas of frequent movement, like the shoulder or knee, are constantly under strain, leading to collagen being deposited in a wider, more noticeable pattern. Surgical technique aims to mitigate this tension by placing layers of deep, internal dissolvable sutures to bear the load, allowing the surface wound to heal with minimal stress. When the skin edges are loosely approximated, the resulting scar line tends to be much finer and less prone to widening.
Patient Biology
Patient biology introduces variables, including genetic predisposition to abnormal scarring. Individuals with a history of keloids or hypertrophic scars (raised, thick scars that grow beyond the original wound boundary) have an increased risk regardless of the suture type used. Age also plays a role, as younger skin often generates a more vigorous, collagen-rich healing response, which can initially result in a thicker scar.
Post-Suture Care
Post-suture care is the patient’s greatest tool in minimizing long-term scar visibility. Protecting the healing tissue from the sun’s ultraviolet rays is paramount, as sun exposure can cause permanent darkening of the new scar tissue. Once the surface wound is fully closed (usually after several weeks), consistent massage and the application of silicone sheets or gels can help flatten and soften the scar. These actions give the scar the best chance to mature into a thin, pale line over the course of the healing year.