SKIN CLEAVABILITY and course of wrinkles on the face and neck

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SKIN CLEAVABILITY and course of wrinkles on the face and neck Prof. Peter Stanko, MD, PhD Oral and Maxillofacial Surgeon Dpt. of Stomatology & Maxillofacial Surgery Comenius University, St Elisabeth Hospital

Principles of cleavability - 1 In deeper layer of the corium -collagen and -elastic fibres have quite regular course at various locations and in all people are the same. This fact is visible by wringle formation on the head and neck.

Principles of cleavability - 2 In general the course of the wrinkles is vertical to fibres of muscles: of the mimic muscles i. e. muscles of facial expression (on the face) and of the platysma (on the neck).

Principles of cleavability - 3 Cleavage lines on the skin after Lang (established by puncture method on the whole body) run in the course of natural wrinkles on the face and neck. They help surgeon decide on course and shape of the skin incision by operation (surgical procedures).

Cleavability of skin after Lang (Lindeman Anatomy)

The courses by skin incision must be respected: ● Horizontal ● Vertical ● Oblique ● Collar form.

The courses by skin incision must be respected: ● Horizontal on the forhead the incisions are vertical to venter frontalis musc. occipitofrontalis on the nasal root to musc. corrugator supercilii on the suprahyoid part of the neck e. g. ▪ submental and ▪ submandibular incisions.

Cleavage lines after Lang (Lemeš L. a kol Cleavage lines after Lang (Lemeš L. a kol.: Topografická anatomie pro stomatology. Praha, Avicenum 1984, 246 s.)

Horizontal suprahyoid incisions Submental incision Submandibular incision

The courses by skin incision must be respected: ● Vertical on the lips from midline inclinated to side on the cheeks. ● Oblique on sulcus palpebralis sulcus nasolabialis sulcus mentolabialis. ● Collar form (similar to horizontal) - on the infrahyoid part of the neck.

LIPS – musc. orbicularis oris Sulcus nasolabialis Sulcus mentolabialis

Cleavage lines after Lang (Jatin Shah, boat-shaped excisions/form of eucalipt letter)

Practical notice to skin incision The best way how find out the correct course of the skin incision is: taking the skin within fingers and - attempt form the natural wrinkles. This will show you the course!