The subcuticular closure is achieved with loose superficial bites of 3-0 Monocryl. If deep bites are used, or if backtracking is performed, the circulation to the skin edges may be compromised. This is especially true if the vertical skin closure is gathered too much.
Several surgeons will add a T at the end of the procedure to avoid waiting for the pucker to settle . This is especially tempting for those who are moving from their comfort level with the inverted T approaches, but De Mey has shown that his revision rate was not improved by adding a T at the end of the procedure . Many of us may add a T in the very large reductions, but we still prefer the coning that results with this approach and we are not reverting to what one normally thinks of when discussing an inverted T with an inferior or central pedicle.
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