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Running subcuticular suture for closure of defect following surgical excision of xanthelasma palpebrarum
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Received: ,
Accepted: ,
How to cite this article: Gajula AS, Kotekar S, Behera T, Kumar S. Running subcuticular suture for closure of defect following surgical excision of xanthelasma palpebrarum. CosmoDerma. 2026;6:70. doi: 10.25259/CSDM_76_2026
PROBLEM
Surgical excision is a commonly used treatment for xanthelasma palpebrarum (XP). Owing to the thin and lax nature of eyelid skin, post-excisional defects are often closed with simple interrupted or mattress sutures.[1] Although effective for approximation, these suturing methods may leave visible suture marks on the delicate eyelid skin, which can compromise the final cosmetic outcome and reduce patient satisfaction.[2] In addition, minor irregularity of edge apposition may make the scar more conspicuous in this highly visible anatomical site. A closure technique that minimizes surface suture marks while allowing the scar to blend with the natural eyelid folds may therefore offer a cosmetic advantage.
SOLUTION
To improve cosmetic outcomes after XP excision, wound edge approximation can be completed using a running intradermal subcuticular 6-0 polypropylene suture, secured with floating knots at both ends [Figure 1 and Video 1]. When required, one or more buried absorbable sutures, such as 6-0 polyglactin or polydioxanone, may first be placed to approximate the deeper layer and reduce tension before the running subcuticular closure is performed. The laxity and thinness of eyelid skin make it particularly suitable for this technique. As the suture traverses within the dermis and requires only terminal knots, it avoids the multiple surface entry and exit points seen with interrupted sutures, thereby minimizing track marks. This helps preserve the natural contour of the eyelid and allows the final scar to merge more seamlessly with the surrounding skin folds [Figure 2]. The superficial polypropylene suture can be removed after 5–7 days. In our patient, follow-up at 12 weeks after complete excision showed an almost seamless scar with a satisfactory cosmetic outcome.
Video 1:
Video 1:Following surgical excision of xanthelasma, a vertical buried suture (6-0 Monocryl) is placed for approximation of edges, followed by a running subcuticular suture (6–0 Prolene) for precise closure. Video available on: https://doi.org/10.25259/CSDM_76_2026Ethical approval:
Institutional review board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Xanthelasma: An update on treatment modalities. J Cutan Aesthet Surg. 2018;11:1-6.
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