Carefully evaluate the skin creases around the orbit. If tissues are edematous, the skin surrounding the opposite orbit can be used to obtain an appreciation for the direction of creases. If a lid crease is not readily detectable, a curvilinear incision along the area of the supratarsal fold that tails off laterally over the lateral orbital rim works well. The incision should be similar in location and shape to the superior incision in a blepharoplasty (Fig. 5-2). The incision, however, may be extended farther laterally as necessary for surgical access. The incision should begin at least 10 mm superior to the upper lid margin and be 6 mm above the lateral canthus as it extends laterally. The incision line is marked before infiltration of a vasoconstrictor. The tissues distort following infiltration, and therefore a perceptible crease may disappear after injection.
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