Best direction of surgical incision on back of thigh for less scarring?

Question

I am having a lipoma removed from the back of my thigh, 2 inches above the knee. It's 5cm horizontal and 2cm vertical in shape. Which is the best direction for surgical incision to reduce scarring? I've been told horizontally as it follows Langer lines, but was also told vertically is better as when you elongate leg the skin will pull on scar and stretch it, so a horizontal incision would get wider from this. Which is right?

Raffy Karamanoukian, MD, FACS · Answer

Lipomas are benign fatty tumors that occur under the skin and less commonly within the muscle. They are associated with mild discomfort and a lump underneath the skin. It is always best to talk to an expert plastic surgeon to determine whether the lipoma is possibly a cyst or a tumor or hernia. We would have to remove the lipoma to be sure that it is not something else and we usually do this by sending it to a pathologist for evaluation. If a lipoma is painful, then an exam is needed to make sure it is not compressing on a nerve or whether the diagnosis is different. Aftercare for a lipoma includes gentle compression and Plato’s Scar Serum twice daily on the wound.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Miguel Mascaro, MD · Answer

It depends on your personal skin as it creates creases during flexion and extension.  During physical examination your surgeon will be able to design something that is as cosmetically pleasing (and functional) as possible.  Most frequently we do like to follow Langer lines, but you are right, sometimes its best to go against them.  Best of luck! I hope some of this helps.

Nelson Castillo, MD · Answer

Thank you for your excellent question.  Though we like to respect Langers lines in order to have the most pleasing scar, as well as to limit possible contractures, they are fluid and variable in each patient.  If when you bend and extend your knee the area of anticipated incision results in horizontal wrinkles it would be best to have a horizontal incision.  If however it is unaffected, a vertical scar would be better.  Talk to your surgeon, they can offer you the best advice after an in-person examination.

Best direction of surgical incision on back of thigh for less scarring?

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Best direction of surgical incision on back of thigh for less scarring?

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