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Free margins
Free margins
Free margins, such as the lips, eyelids, alar rims, and helical rims, are both more susceptible to distortion (given their lack of bony attachments) and more cosmetically obvious when distorted (given their prominence in facial cosmesis) than other areas on the face. Therefore, preserving the position of the free margins is of great importance. Free margins can be both pulled (as in a lower eyelid ectropion caused by downward pull on the lower lid) and pushed (as in an upper lip closure forcing a section of dogear downwards). Keep in mind the potential for central axis lengthening as a result of wound closure, as this โpushingโ effect due to the differential between the length of the central axis (apex to apex) and the (longer) length of each of the outside wound edges means that postoperatively the length of the linear closure will be longer than anticipated; this may impact repairs around the lips, where tissue may be pushed leading to an immediate postoperative puffiness which often resolves spontaneously.