Skin Marking in Upper Blepharoplasty—Avoiding Pitfalls

Abstract

At surgery, the skin marking is probably one of the most important steps and therefore warrants careful attention to detail. The placement of the skin incision is crucial to the perceived success of the surgery postoperatively as the eyelid crease is the most distinguishing feature of the upper lid. I prefer to mark the incisions with a fine-tip marking pen prior to injection of local anesthetic to avoid distortion of the tissues from the anesthetic. The eyelid crease heights are first measured and compared on both upper eyelids. If they are symmetric and appropriate for gender (8–11 mm for women, 6–8 mm for men), the creases are marked with the pen (Figure 20.1). Occasionally, the crease heights are asymmetric, contain double lines, or are discontinuous. Therefore, careful comparison between the two sides will help guide the proper placement. In addition, if involutional ptosis is also present, the eyelid crease will be anatomically elevated up to height of 15–20 mm (due to dehiscence of the anterior fibers of the levator aponeurosis that attach to dermis and skin at the level of the lid crease). Placement of the incision at these elevated crease levels would result in a suboptimal and unnatural appearance to the eyelids.