When an oval or circular lesion is excised and the defect is closed directly the resulting scar is always considerably longer than the original lesion, a fact which it is always wise to explain to the patient. When the curved lines, ellipse up to circle, resulting from the excision are brought together in a straight line the effect is to lengthen the scar.
In addition, closure of the ellipse almost invari-ably leaves a ‘dog-ear’ at each end of the suture line, and the correction of this lengthens the scar still further. To remove a dog-ear the wound should be sutured until the elevation becomes pronounced. A hook placed in the end of the wound and raised defines the extent of the dog-ear. The elevation is then excised by incising around the base on one or other side, finishing in the line of the wound.
The resulting flap is brought across the wound so that the excess skin can be defined and removed. The resulting line has a slight curve and its direction, which depends on the side of the dog-ear cut initially, can be chosen to fit the best line cosmetically. Failure to remove the dog-ear leaves a rather unsightly swelling , and although it flattens somewhat with the passage of time, it does tend to remain prominent enough to mar an otherwise satisfactory result.