The dynamic rotation of Langer's lines on facial expression

Karl Langer investigated directional variations in the mechanical and physical properties of skin [Gibson T. Editorial. Karl Langer (1819-1887) and his lines. Br J Plast Surg 1978;31:1-2]. He produced a series of diagrams depicting lines of cleavage in the skin [Langer K. On the anatomy and physiology of the skin I. The cleavability of the cutis. Br J Plast Surg 1978;31:3-8] and showed that the orientation of these lines coincided with the dominant axis of mechanical tension in the skin [Langer K. On the anatomy and physiology of the skin II. Skin tension. Br J Plast Surg 1978;31:93-106]. Previously these lines have been considered as a static feature. We set out to determine whether Langer's lines have a dynamic element and to define any rotation of the orientation of Langer's lines on the face with facial movement. One hundred and seventy-five naevi were excised from the face and neck of 72 volunteers using circular dermal punch biopsies. Prior to surgery a vertical line was marked on the skin through the centre of each naevus. After excision distortions of the resulting wounds were observed. The orientation of the long axis of each wound, in relation to the previously marked vertical line, was measured with a goniometer with the volunteer at rest and holding their face in five standardised facial expressions: mouth open, smiling, eyes tightly shut, frowning and eyebrows raised. The aim was to measure the orientation of the long axis of the wound with the face at rest and subsequent rotation of the wound with facial movement. After excision elliptical distortion was seen in 171 of the 175 wounds at rest. Twenty-nine wounds maintained the same orientation of distortion in all of the facial expressions. In the remaining wounds the long axis of the wound rotated by up to 90°. The amount of rotation varied between sites (p > 0.0001). We conclude that Langer's lines are not a static feature but are dynamic with rotation of up to 90°. It is possible that this rotation in the axis of mechanical tension will affect the appearance of the resulting scar. © 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons.