1. 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

2. 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.

3. 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).

4. 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).

5. Cleavability of skin after Lang (Lindeman Anatomy)

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

7. 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.

8. 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.)

9. Horizontal suprahyoid incisions
Submental incision
Submandibular incision

10. 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.

11. LIPS – musc. orbicularis oris
Sulcus nasolabialis
Sulcus mentolabialis

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

13. 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!