Dermatologic Microsutures Using Human Hair

A Useful Technique in Cutaneous Stitching

Mohammed Al azrak, MBBCh, MSc, FEBOPRAS, FACS; Rei Ogawa, MD, PhD, FACS


ePlasty. 2017;17(e24) 

In This Article


Patient and Wound Characteristics

The case series consisted of 54 females with 56 facial traumatic wounds. All patients were Egyptian (Afro-Mediterranean race) and their average age was 10.8 (range, 3–45) years. The average length of the wounds was 3.6 (range, 1–12) cm. The depth of the wounds ranged from being only cutaneous (9 wounds, 16.1%) to involving both the skin and subcutaneous tissues (40 wounds, 71.4%) to reaching the muscles (7 wounds, 12.5%). The wounds were either pure cut wounds caused by sharp objects (including knives used in acts of violence or the sharp edges of broken glass that were encountered accidentally) or lacerations or contusions caused by the blunt edges of crushing objects (see panel a in Figure 2, Figure 3 and Figure 4). The most common locations of the wounds were the lateral forehead (n = 14; 25.0%), followed by the periorbital region (n = 13; 23.2%), the mid part of the forehead (n = 8; 14.3%), and the perioral region (n = 7; 12.5%) (Table 1).

Figure 2.

The facial wound before and after stitching and the scar at 6 months in case 1. (a) This 14-year-old girl had a simple facial cut wound that was 3-cm long. (b) The view 1 week after stitching with an autologous hair filament. (c) Six months later, there is no marked disfiguring scar. Suture marks cannot be seen.

Figure 3.

The facial wound before and after stitching and the scar at 5 weeks and 6 months in case 2. (a) This 7-year-old girl had a deep facial wound that was 6-cm long and involved injury to the skin, subcutaneous area, and muscles. (b) The view immediately after deep wound repair and epidermal stitching with an autologous hair filament. (c) The view 5 weeks after stitching. (d) The view 6 months after stitching. There is good healing and no marked disfiguring scar or suture marks.

Figure 4.

The facial wound before and after stitching and the scar at 3 months in case 3. (a) This 6-year-old girl had a deep facial wound that was 4-cm long. (b) The view 6 days after suturing with superficial autologous hair sutures. (c) The view 3 months after stitching. A nice healing line can be seen. There are no suture marks.

Surgical Characteristics

For anesthesia, most patients (n = 41; 75.9%) underwent local injection combined with intravenous sedation. The remainder underwent local injection alone (n = 7; 13.0%) or general anesthesia (n = 6; 11.1%).

In terms of stitching, most wounds (n = 47; 83.9%) received simple interrupted stitches and surgical knots. The remaining 9 wounds (16.7%) received simple continuous sutures.


The sutured wounds were examined every 3 days on average, and the stitches were removed 6 to 15 days after closure. A few patients did not follow the follow-up timetable properly. As a result, the stitches were sometimes left in place for 2 weeks, without any apparent ill effects.

Wound Outcomes

In all cases, there was good coaptation of the wound edges along the length of the wound and the scars that were left were fine lines that matched well with the surrounding skin in terms of color and texture (Figure 2, Figure 3 and Figure 4). Dehiscence and infection were not detected in any of the wounds/scars. Suture marks across the healing line were not detected in any of the cases even after 2 years of follow-up. The patients and their relatives were generally satisfied with the aesthetic outcomes of the stitching.

Observations During Suturing With Hair

In all cases, the hair was pliable and smooth, provided effective tension, and harmonized with the skin tissue. The knot was secure and did not exhibit dehiscence. The stitches accommodated the local wound edema and did not cut through the edematous tissue. The stitches were easy to remove. The patients appeared to feel less pain on suture removal than our experience with other suture materials. Cost and availability issues were not encountered.