Persistent abnormal traction on an incision can prolong inflammation and disturb collagen deposition, leading to scar widening, elevation or contracture and impairing function and appearance. Because wound-edge loading is time-dependent and multifactorial, single tension-reducing measures are insufficient, and a comprehensive concept centered on combined tension reduction has emerged. This article summarizes strategies such as preoperative incision design along relaxed skin tension lines, meticulous intraoperative multilayer suturing and suture selection, postoperative external fixation with tapes or devices, and adjunctive botulinum toxin type A to lessen muscle-related traction, with particular attention to high-tension regions such as the trunk and face. We describe how the intensity of tension reduction can be tailored to incision location and individual risk factors, and emphasize ongoing management of wound-edge tension around the perioperative period, providing a practical reference for preventing and managing pathological scars associated with high-tension incisions.