Skin Marking in Cosmetic Upper Blepharoplasty
Surgical precision starts with skin marking.
Eyelid surgery is an art form that requires meticulous planning prior to the first cut. Marking of the eyelid skin for excision is arguably the most important step in cosmetic eyelid surgery and blepharoplasty, particularly since millimeters count in that area.
Prior to performing cosmetic upper eyelid blepharoplasty, I spend extra time designing the blepharoplasty incision lines and precisely marking the eyelid skin in preparation for surgical excision.
First, I start with marking of the eyelid crease. I normally use the pre-existing crease, unless it is too high or too attenuated (usually due to ptosis).
I then angle the inner and outer aspects of the markings in an upward slant. This prevents epicanthal webbing and “dog-ear” formation, and allows the skin to close and heal nicely in a relaxed fashion without undue tension, thus minimize unsightly scarring.
Using the “pinch technique,” I mark three points of maximal skin excision, nasally, centrally, and laterally. These points delineate the amount of eyelid skin that can be safely removed without compromising the closure of the eyelids.
Then, I connect the dots (they don't have to connect perfectly)