The Direction of Optimal Skin Incisions Derived from Striae Distensae

In an effort to achieve inconspicuous scars, plastic surgeons try to place their incisions in established creases and folds of skin. Although well established in the face and abdomen, these folding lines are often disputable on other parts of the body. Striae distensae always develop perpendicular to lines of tension, and their direction can be used to determine optimal incision lines. The authors examined photographs of 213 individuals with striae, and a composite diagram was created. This composite along with descriptions of Langer lines, Pinkus main folding lines, and Kraissl lines were compared with a clinical scar revision database and 276 images of incisions and scars from the Internet. Pinkus described the main folding lines in 1927 and Kraissl in 1951 recommended that incision lines be placed perpendicular to the direction of underlying muscles. Both references bear some similarities to what we noted in our composites. In comparison, Langer lines, although of historical interest, poorly predicted the direction of optimal skin incisions. The optimal direction for surgical skin incisions should take into strong consideration patterns defined by nature's striae distensae, which always develop perpendicular to skin tension lines. Main folding lines can be used as guides when addressing or refining problem scars and similarly facilitate surgical planning of elective incisions, which may prevent problem scar formation for our patients.