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Lemperle Plast Aesthet Res 2020;7:40 I http://dx.doi.org/10.20517/2347-9264.2020.14 Page 19 of 25

A B

Figure 24. Vertical pararectal hypertrophic scar after cholecystectomy, corrected by horizontal conversion in the main folding lines (A
[11]
and B) (both figures are reproduced with permission from Lemperle et al. )

A B

Figure 25. On the dorsal neck, the folding lines run horizontally, but vertically above the scapula. In young patients, horizontal incisions
may develop hypertrophy (A and B)

Leg and foot
Inconspicuous striae often develop on the inner thigh and posterior knee in a vertical direction [Figure 11A]
and only rarely on the anterior surface of the thigh, where they develop vertically. Above the knee,
horizontal folding lines surround the patella and should be used for the excision of suprapatellar fat pads
and half-circular incisions either medial or lateral to the patella [Figure 13B], rather than the commonly
used vertical incision straight across the knee [Figure 27A and B].

On the lower leg across the calf, striae generally run vertically and in an oblique direction from lateral
proximal to medial distal. The skin folds on the lower extremities are analogous to those of the upper
limbs. Therefore, oblique incisions from medial proximal to lateral distal over the calf and oblique incisions
from proximal posterior to distal anterior over the fibula, are recommended in young patients with selected
indications.