Page 433 - Read Online

Page 2 of 25 Lemperle Plast Aesthet Res 2020;7:40 I http://dx.doi.org/10.20517/2347-9264.2020.14

A B

C

Figure 1. Some Langer’s “cleavage lines” run oblique or perpendicular to the recommended “main folding lines” on forehead, lower
abdomen, buttocks and extremities (A); on the other hand, some Langer’s cleavage lines run parallel to the “main folding lines” over
neck, shoulders, upper abdomen and back and therefore correctly in the direction of the proposed “tension lines” (B) (both figures
[11]
are reproduced with permission from Lemperle et al. .); langer punched round holes into cadaver skin at various sites to determine
invisible “cleavage lines” (C) (Drawings by Mark Moore 2011)
adolescents are still prone to develop hypertrophic scars, which could be prevented by surgical incisions in
the direction of the main folding lines (MFL) of the skin. The list of ineffective treatments for scars is long,
including heparin, panthenol and silicone creams, needling rollers, and laser therapy. However, pressure
dressings and corticosteroid injections are the only effective treatments in fresh and surgical excision of
mature hypertrophic scars, while injectable dermal fillers can be used in broad indented hypotrophic scars.

Surgical and orthopedic textbooks do not mention natural folding lines for optimal surgical incisions.
The purpose of this review is to facilitate the determination of optimal incision lines perpendicular to the
direction of striae distensae.

History of surgical incision lines
When consulted to correct conspicuous scars from prior surgeries, some surgeons still rely on Langer’s
invisible “cleavage lines” described in 1861 , which run perpendicular to skin folds in several regions of
[1]
the body [Figure 1A and B]. However, folds and folding lines are easily determined in adults by bending a
joint or pinching the skin in different directions.