Use of natural lines Incisions should be placed wherever possible so that the scar will lie in a line of election, or at least parallel to it , so that in the course of time it will settle in to look like another wrinkle. Even if wrinkling is not actually pres-ent, the site and line of the wrinkles likely to develop in the future can often be found by getting the patient to simulate the appropriate facial expression, e.g. smiling, frowning, closing the eyelids tightly, etc.
This brings the more obvious potential wrinkle lines into being. The most generally useful wrinkles are the nasolabial fold, the glabellar wrinkle pattern, the lateral canihal ‘crow’s foot’, the forehead wrinkles, each a site which overlies one of the main con- centrations of the muscles of facial expression. Where these are absent, as over the masseter, the wrinkle pattern is less clear cut, and in the ear and nasal tip it is completely lacking.
In the older patient, additional wrinkling results from the effect of gravity on a back-ground of skin slackness. In many ageing faces the criss-cross of fine wrinkling is a mixture of gravity wrinkling and expression lines. The smooth skin of the child can make it extremely difficult, especially away from the eyes and mouth, to select the best line for an incision.
Fortunately, the need to make the choice is rare. The use of a natural junction line has the effect of distracting the eye from a scar and can be used to good effect. Examples are the junction lines between nose and face especially around the base of the ala, the nostril rim, the margin between the red border of the lip and the skin, the junction line between the ear and the masseteric region, and in the lower eyelid just below the line of the eyelashes.
These and others are used routinely to distract the eye of the observer and render the scar less conspicuous.