Langer Lines Over the Buttocks
For surgical incisions on the buttocks, orient incisions horizontally along the infragluteal fold or within the sacral triangle region, as these directions follow natural skin tension lines and provide optimal cosmetic outcomes with well-concealed scars.
Optimal Incision Orientation
The buttock region requires special consideration for incision placement to minimize tension and scarring:
- Horizontal orientation is preferred for most buttock incisions, following the general trunk pattern where skin tension lines run predominantly horizontal except at the shoulder and scapular regions 1
- Infragluteal fold incisions provide excellent concealment and follow natural tension lines, allowing scars to be hidden even with minimal swimwear 2
- Sacral triangle incisions that proceed downward slightly off the gluteal midline and continue along the infragluteal fold have demonstrated successful outcomes with well-hidden scars 2
Technical Principles for Execution
Incision Planning
- Use curvilinear incisions following Langer's lines as the standard approach for optimal cosmetic results, as this technique achieves the best cosmetic outcomes across body regions 3, 4
- Measure skin anisotropy preoperatively when possible to objectively determine collagen orientation and place incisions parallel to lines of minimal longitudinal stretch 5
- Placement of incisions parallel to collagen fiber orientation minimizes mechanical forces on healing wounds and reduces hypertrophic scar formation 5
Closure Technique
- Close all incisions with subcuticular technique to optimize cosmetic results and minimize visible scarring 3, 6
- Preserve subcutaneous tissue with separate closure to improve cosmetic outcome and structural integrity 3, 7
- Ensure adequate incision length to permit complete tissue removal without excessive tension 6
Critical Hemostasis Requirements
- Meticulous hemostasis is critically important to prevent hematoma formation, which produces changes difficult to interpret on examination and complicates healing 3, 6, 7
- Hematomas can be long-lasting and lead to unnecessary interventions due to difficulty in evaluation 6
Common Pitfalls to Avoid
- Never reapproximate tissue in a manner that creates tension when the patient is upright, even if it appears adequate when supine, as this causes wound distortion and increases scarring risk 3, 6, 7
- Avoid vertical incisions on the buttocks unless specifically indicated, as they work against natural tension lines in this region 1
- Do not place incisions that will be visible with standard clothing or swimwear when alternative well-concealed locations are available 2
Evidence Considerations
The recommendation for horizontal orientation on the buttocks is supported by large-scale in vivo biomechanical studies showing clear directional preferences for excisional skin tension lines across body regions 1. While traditional Langer's lines were derived from cadaveric studies, modern biodynamic excisional skin tension line research demonstrates that trunk incisions should be predominantly horizontal 1. Clinical outcomes from gluteal reduction procedures confirm that incisions along the infragluteal fold and sacral triangle provide excellent cosmetic results with high patient satisfaction 2.