Incisional Guidelines When Marking the Skin in Upper Eyelid Blepharoplasty

Abstract

When marking the upper lids, always leave behind at least 2 cm of skin between the lash margin and lower eyebrow hairs and you should never have difficulty with postoperative lagophthalmos. This means that the upper limit of skin excision should leave 10–15 mm of skin between the inferior brow and upper skin incision. This limit can be marked at the beginning of the case as a reminder.

For those patients without a discernible lid crease (Fig. 20.1), the following measurements can provide a good incisional guideline:

Fig. 20.1

Artist’s sketch depicting incision guidelines for upper eyelid blepharoplasty. (a) Preoperative sketch of upper eyelid dermatochalasis. (b) Castroviejo calipers are used to measure the eyelid. (c) Planned incision. (d) Skin excision closed with running suture

• 7–9 mm above the mid-eyelid margin for men and 8–10 mm for women

• 6 mm above the medial eyelid margin at the level of the punctum

• 6–8 mm above the lateral eyelid margin at the level of the lateral canthus

• Lateral eyelid crease incision then swings upward at the lateral canthus to end 15–18 mm from the lateral canthus at a 45° angle

An axiom that is useful for those starting out: always leave behind at least 2 cm of skin between the lash margin and lower eyebrow hairs and you should never have difficulty with postoperative lagophthalmos. This means that the upper limit of skin excision should leave 10–15 mm of skin between the inferior brow and upper skin incision. This limit can be marked at the beginning of the case as a reminder.