Revisiting the Skin Lines on the Forehead and Glabellar Area.

This paper attempted to revisit the skin lines in forehead and glabellar area. Using PubMed, Scopus, and Google, papers describing skin tension lines of face were searched. Papers with illustrations or pictures of the facial lines were selected and reviewed. The studies of the skin lines in the forehead and glabellar area were analyzed. Langer used the term "cleavage of the cutis, anatomical lines." Over the forehead, he found a border zone of horizontal folds that were interrupted many times by the ascending folds coming from the flabella area. Cox used the terms "cleavage lines of the skin" and "lines of increased tension." In the glabellar area, cleavage lines were vertical and extended to the forehead. Rubin used the term "skin line." In the midline area over the nose, the skin wrinkled vertically. Kraissl used the term "normal wrinkle line." Above the nose, "curving vertical lines" were observed. Straith et al used the terms "normal tension line," and "Langer line." In the glabellar area, the horizontal lines from the upper eyelids became "curved vertically" until meeting the supra-brow horizontal line. Borges used the term "relaxed skin tension line." At the medial end of the eyebrow, his relaxed skin tension line ran obliquely upward and medially, to meet the contralateral line. Namikawa et al used the term "cleavage lines of the skin." It ran mediosuperiorly to inferolaterally, bordering the linea mediana anterior in glabellar area. Following the consensus of most authors, a curved vertical line following the glabellar frown is recommended for incisions for flaps or grafts. (C) 2017 by Mutaz B. Habal, MD.

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