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Page 4 of 25 Lemperle Plast Aesthet Res 2020;7:40 I http://dx.doi.org/10.20517/2347-9264.2020.14
A
B
Figure 3. Pinkus’ “main folding lines” (MFL) of the skin facilitate optimal incision lines. These drawings, however, are irritating to a
surgeon because they are not clearly defined at the extremities (A); a drawing of collected striae gravidarum by Pinkus in 1927 (B) (both
[11]
figures are reproduced with permission from Lemperle et al. )
be absent in younger patients. Interestingly, the stripes of tigers and zebras, and the folds in Sharpei dogs
follow similar lines, transverse at the torso and extremities, and concentric towards the inner side of large
joints.
Aesthetic surgeons learn to follow specific directions for incisions, and reconstructive surgeons may be
uncertain of the optimal direction. General surgeons focus on the fastest and most direct way to reach the
abdominal cavity, while orthopedic surgeons focus on the most convenient way to access a bone or joint.
Surgical and orthopedic textbooks do not mention natural folding lines for optimal incisions [9,10] . The
