Vertical forehead lacerations tend to have a more visible scar because they traverse the skin tension lines Complex forehead wounds, such as stellate lacerations from windshield impact and those with tissue loss, particularly secondary to animal bites, may require consultation with a plastic surgeon Forehead lacerations are rarely associated with skull fractures, but facial or intracranial injuries should be ruled out Eyebrow Lacerations Eyebrow lacerations are common Repairing an eyebrow laceration is complicated by the presence of hair It is advisable not to shave the eyebrow for wound preparation because it serves as a landmark during repair Also, eyebrow regrowth is unpredictable; it may be either slow or incomplete, potentially leading to poor cosmetic outcome Debridement, if required, should be minimal and along the same axis of the hair shafts to avoid damage to hair follicles; otherwise, alopecia of the brow will result Closure with simple interrupted stitches using nonabsorbable material is usually sufficient Attention must be paid to avoid inverting the hair-bearing edges into the wound It is also important to pay attention to proper alignment of both ends of a wound along an eyebrow Eyelid Lacerations Most eyelid lacerations are simple transverse wounds of the upper eyelid just inferior to the eyebrow Repairing these wounds does not require any special skills Well-approximated lacerations in the transverse crease of the eyelid will heal well if left alone However, recognizing complicated eyelid lacerations is crucial for proper repair and optimal outcome (see Chapter 114 Ocular Trauma ) Vertical lacerations involving the lid margin require precision in approximation to avoid deformity and malfunction of the eyelid Injuries potentially involving the levator palpebrae muscle, medial canthal ligament, or lacrimal duct should be considered for ophthalmology referral A high index of suspicion for lacrimal duct injury is particularly important when evaluating a medially positioned lower eyelid laceration If not repaired, inferior duct injury may lead to chronic tearing as the lower lacrimal duct is the main drain of tears from the conjunctival sac Evaluation for an associated injury of the globe is a must, particularly if periorbital fat is exposed or tarsal plate penetration is present (see Chapter 114 Ocular Trauma ) External Ear Blunt Trauma and Lacerations Although the ears are subject to trauma because of their exposed position, lacerations involving the ears are rather rare The auricle contains a cartilaginous