Skin Tension Lines

I am wondering if my excision scars were placed in the opposing direction of skin tension lines. I have a vertical scar on my forehead mid way between my eyebrows and about an inch above them. The one on my nose is also vertical on the upper side of my nose. Are these opposing natural skin tension lines and if so, could there be a reason for that placement?

Doctor Answers 2

Scars Should Be Placed Parallel To Skin Tension Lines If Possible

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In the glabellar area (between the eyebrows), the relaxed skin tension lines do run vertical for a short distance. In the remainder of the forehead, the tension lines run horizontal. Where the forehead tension lines lie is evidenced by where the forehead wrinkles occur by frowning and raising your eyebrows. On the nose, the skin tension lines run parallel to the long axis of the nose until one gets down to the tip. Why your excision scars run where they do is undoubtably a function of the location and size of what needed to be removed. It may simply have not been possible to place all of the excision pattern in the most ideal skin tension line orientation. 

Wound closure in relation to skin tension lines

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There are many considerations in selecting the orientation of wound closure.  Generally for the greatest strength of closure and best cosmesis, I prefer to orient wounds parallel to relaxed skin tension lines.  On the face and other cosmetically improtant areas, there are other considerations including the location of the adjacent tissue reservoir, as well as potential disruption of important neighboring structures such as the eye, nose, ear, lip.  Yet another consideration is the long-axis orientation of the wound that needs to be closed.  Any one of these or other considerations could have played a factor in the orientation of your excision scars. 

Bryan K. Chen, MD
San Diego Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.