Making Facial Incisions

Family physicians are often called upon to remove small lesions from patient's faces. When performing these procedures it is important to avoid incisional scarring that tethers or pulls the skin. This article by Dr. Michael Brennan, a plastic surgeon at St. Martha's Regional Hospital, will help with avoiding these pitfalls.

Face at rest

Before making any incisions look at the patient's face at rest to get a sense of the naturally occurring lines.

Forehead

When removing a lesion on the forehead have the patient wrinkle the brow first. See how the lines run transversely across the forehead. Your incision should be made to conform to these lines.

Area around the eyes

For lesions around the eyes have the patient squint. Note the lines that form and make your incision accordingly.

Nose

Incisions for lesions found high on the nose, between the eyes are made transversely. Generally incisions along the nose are made longitudinally.

Nasolabial folds

The nasolabial folds provide guidance for incisions in this area of the cheek.

Cheek-1

For lesions on the cheek, it is a good idea to have the patient smile. An elliptical incision can then be made to conform to these smile lines. When sutured this incision will form a curved scar.

Cheek-2

Prior to making any incision it is wise to outline the area with a surgical pen. This will keep you on target.

Upper Lip

Incisions of the upper lip are made longitudinally.

Mouth

Incisions around the mouth can be mapped by applying a little pressure on the skin lateral to the mouth.

Chin

Chin incisions are made longitudinally, although incisions at the margin of the lower lip are made transversely.

Submental region

Incisions in the submental region are made transversely, as demonstrated by this picture.

- Michael Brennan

Thanks to Dr. Mihkel Oja, Plastic Surgeon at the Dr. Everett Chalmers Hospital in Fredericton, New Brunswick for reviewing the draft copy of this article.