Tension lines of the skin

Abstract

Skin tension lines are natural lines of tension that occur within the skin as a result of growth and remodeling mechanisms. Researchers have been aware of their existence and their surgical implications for over 150 years. Research in the twentieth century showed clearly, through destructive mechanical testing, that the orientation of skin tension lines greatly affects the mechanical response of skin in situ. More recent work has determined that this anisotropic response is, at least in part, due to the structural arrangement of collagen fibres within the dermis. This observation can be incorporated into mathematical and mechanical models using the popular Gasser-Ogden-Holzapfel constitutive equation. Advances in non-invasive measurement techniques for the skin, such as those based on elastic wave propagation, have enabled patient-specific identification of skin tension lines in an accurate and rapid manner. Using this technique on humans, we show that there is considerable variation in the level of anisotropy as the skin ages. Furthermore, we identify that both the structural arrangement of fibres and the in vivo levels of pre-strain play a significant role in the anisotropic behavior of skin.