Brief Summary

Inverting mattress sutures cause tissue inversion, which can be used to recreate a natural indentation or crease. This technique can improve cosmesis in areas such as the mental cleft, alar rim, nasolabial fold, or eye margins.


  1. Start with a “big bite” with the needle oriented parallel to the wound, entering the tissue approximately 5mm from the wound edge.
  2. Exit at approximately the same distance from the wound on the same side.
  3. Reload needle in a backhanded fashion and enter the tissue on the opposite side of the wound, again oriented in parallel with the wound.
  4. Exit at approximately the same distance as the original entry point on the opposite wound edge. The four entry and exit points should form a square bisected by the wound.
  5. Instrument tie.