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To date, a detailed analysis of keloid distribution focused specifically on facial and neck areas has not been reported, and limited literature exists as to the related mechanical factors. To rectify this deficiency of knowledge, we first quantified the facial and neck keloid distribution observed clinically in 113 patients. Subsequently, we performed a rigorous investigation into the mechanical factors and their associated changes at these anatomic sites in healthy volunteers without a history of pathologic scarring. The association between keloid\u2010predilection sites and sebaceous gland\u2010dense and acne\u2010prone sites was also examined. To assess skin stretch, thickness and stiffness, VECTRA, ultrasound and indentometer were utilised. Baseline skin stiffness and thickness were measured, as well as the magnitude of change in these values associated with facial expression and postural changes. Within the face and neck, keloids were most common near the mandibular angle (41.3%) and lateral submental (20.0%) regions. These areas of increased keloid incidence were not associated with areas more dense in sebaceous glands, nor linked consistently with acne\u2010susceptible regions. Binomial logistic regression revealed that changes in skin stiffness and thickness related to postural changes significantly predicted keloid distribution. Skin stiffness and thickness changes related to prolonged mechanical forces (postural changes) are most pronounced at sites of high keloid predilection. This finding further elucidates the means by which skin stretch and tension are related to keloid development. As a more detailed analysis of mechanical forces on facial and neck skin, this study evaluates the nuances of multiple skin\u2010mechanical properties, and their changes in a three\u2010dimensional framework. Such factors may be critical to better understanding keloid progression and development in the face and neck.<\/jats:p>","DOI":"10.1111\/wrr.13180","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T08:55:06Z","timestamp":1712825706000},"page":"419-428","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["In the face and neck, keloid scar distribution is related to skin thickness and stiffness changes associated with movement"],"prefix":"10.1111","volume":"32","author":[{"given":"Hoyu","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7316-8961","authenticated-orcid":false,"given":"Teruyuki","family":"Dohi","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanae","family":"Wakai","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney Laurel","family":"Quong","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo Japan"},{"name":"Department of Plastic, Reconstructive, and Aesthetic Surgery University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Doan Tien","family":"Linh","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Usami","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo Japan"},{"name":"Graduate School of Education The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-555X","authenticated-orcid":false,"given":"Rei","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Regenerative Surgery Nippon Medical School  Tokyo 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