Histological Comparison of the Human Trunk Skin Creases

The Role of the Elastic Fiber Component

Andreas Mallouris, MD, PhD; Despoina Kakagia, MD, PhD; Andreas Yiacoumettis, MD, PhD; Thivi Vasilakaki, MD, PhD; Aggeliki Drougou, MD; Maria Lambropoulou, MD, PhD; Constantinos Simopoulos, MD, PhD; Alexandra K. Tsaroucha, MD, PhD


ePlasty. 2016;16 

In This Article

Abstract and Introduction


Objective: Skin creases are features of major anatomical, morphological, surgical, and functional interest. This study focuses on the histological comparison of creases of the trunk and participation of the elastic fibers in their formation. The histological structure is a key consideration for the reconstructive planning of the relevant area and its knowledge may contribute in such direction.

Methods: Fresh cadaver specimens were collected from the inframammary (n = 15), infragluteal (n = 16), and inguinal creases (n = 14), the anterior axillary fold (n = 14), and the surrounding skin (n = 10). Specimens were fixed in 10% buffered formaldehyde. Collagen and muscle fibers were stained by Masson Trichrome and Van Gieson stains, reticular and collagen type III fibers by Reticulin stain, and elastic fibers by Verhoef and Orcein stains.

Results: Skin creases of the trunk present well-defined dense bundles of collagen fibers, creating a beehive pattern with broad attachment to the dermis and denser in deeper sites related to the fascia of the underlying muscle. The elastic fibers participate in the collagen pattern and radiate in a parallel pattern in the reticular dermis and in a perpendicular fashion in the papillary dermis. The skin surrounding the creases lacks such organization.

Conclusions: Creases of the trunk are formed by well-organized collagen bundles in a beehive pattern, attached to the dermis and related to the underlying muscle fascia. The elastic fibers participate in this structure and radiate in a parallel fashion in the reticular dermis and perpendicularly in the papillary dermis.


Skin creases of the human body[1] are features of great anatomical, developmental, functional, and surgical interest. Skin creases are highly variable regarding their histological and structural characteristics, and this is primarily determined by their location and anatomical site. Their histological structure is a key consideration during surgical planning in skin and soft-tissue reconstructive surgery.[2,3]

As described by Lockwood,[4] connective tissue of the dermis along with the superficial fascia system (SFS) is responsible for the characteristic pattern of lines[5] of the skin, as well as for the fixed and permanent nature of skin creases of the trunk (Fig 1).

Figure 1.

Skin creases of the trunk: (a) inframammary crease; (b) anterior axillary fold; (c) infragluteal crease; (d) inguinal crease; (e) oblique crease of the groin; and (f) suprapubic crease.

There is paucity in the literature regarding the role of the elastic fibers component in skin crease formation.[2,6,7] Several syndromes associated with disorders of the connective tissue involving the elastic fibers present with structural abnormalities concerning the skin creases.[8,9]

The aim of this study was to investigate and compare the histological structure of human trunk skin creases, especially in terms of the role of the underlying dermal elastic fibers. Improving our understanding on this area may be of paramount importance in surgery.