How to place an incision for the best cosmetic result

Since all incisions will become scars, incision placement is critical to a good cosmetic outcome. Figuring out where to place an incision is a compromise between a favorable cosmetic outcome and surgical access to a particular area. Surgeons are constantly trying to find novel ways to make incisions smaller and more hidden while still being able to perform the surgery. 

The best places to hide scars are within relaxed skin tension lines (RSTLs), natural valleys, creases or areas where natural shadows are created.

RSTLs are predictable ways that skin will move and ultimately wrinkle. Incisions should be placed along these lines rather across them. 

Classically, for thyroid and parathyroid surgery the incision is made in the lower part of the neck. A centrally placed incision will allow for access to the thyroid and parathyroid glands on both sides and prevent unnatural asymmetry. Using a natural skin crease (aka wrinkle) provides an excellent hide for incisions. 

We have also learned that we can access the thyroid gland by making incision in areas distant, or often called "remote", to the thyroid itself. Examples would be from the armpit, breast, behind the ear and, more recently, through the mouth. Moving the incision away from a central focus point such as the neck is a great way to hide a scar.