Facial incisions are designed to preserve facial symmetry and motion and to minimize scarring. To remove small skin tumors, make elective incisions in natural skin “wrinkle lines,” if possible (Fig. 1). Generally, these lines run perpendicular to the underlying muscles of facial expression, as they are formed by the repetitive pleating of the skin caused by the action of these muscles. Scars that fall in these lines will be less conspicuous than those that cross these lines.

Traumatic lacerations that cross these lines can sometimes be debrided or modified by Z-plasty to conform to natural wrinkle lines.

Approximate the eyebrow and vermilion border of the lip with special precision because even a small degree of malalignment will be permanently obvious. Never shave the eyebrow as regrowth of eyebrow hair is unpredictable.

The muscles of facial expression (Fig. 2) are innervated by the seventh cranial nerve, aptly named the facial nerve. The anatomy of the facial nerve and parotid region are illustrated in Chapter 1.