Technigue Upper Eyelid Surgery

The amount of excess skin to be removed is marked. The initial incision is made along the normal eyelid crease across the entire lid and extending slight upward and outward into the lateral canthus. The second incision is made a variable distance above the first, depending on the amount of skin to be removed. If the orbicularis muscle is thick or in excess, a small strip may be excised.

The orbital septum is then opened along its entire length, thus exposing the fat pockets overlying the levator aponeurosis (tendon of the eyelid opening muscle). The first or "middle" pocket is removed using a process of dissection, clamping, excision, and cauterization. The second or "nasal" pocket requires deeper dissection. Removal is done is a similar fashion. The skin edges are closed using either dissolving or permanent sutures. The latter seem to give a more predicable and finer scar.