Step 2 Identification of and Marking Incision Line

One should carefully evaluate the skin creases around the orbit. If the tissues are edematous, the skin surrounding the opposite orbit can be used to obtain an appreciation for the direction of creases. If one chooses to use a crease at the midlevel of the lower eyelid, he should note carefully the direction of the skin crease. Commonly, the crease tails off inferiorly as it extends laterally (Fig. 2-13). If access to the orbital floor and inferior orbital rim are all that is necessary, this "lower lid" incision is satisfactory and will result in an imperceptible scar. This incision, however, should not change direction from the original skin crease or a noticeable scar will result. The tendency is to curve the incision superiorly as it extends laterally. This should be avoided, with the incision placed in the middle of the lower lid unless a natural skin crease does the same.

Figure 2-13 Subciliary incision being made. The incision is approximately 2 mm below the eyelashes and can be extended laterally as necessary (top dashed line). It is made throug skin only. If one chooses to use a natural skin crease located more inferiorly for incision (lower dashed line), the incision must follow the crease as it tails off inferiorly. One should not use the lower incision and then extend the incision more superiorly as the lateral orbital rim is approached or the relaxed skin tension lines will be crossed,

Figure 2-13 Subciliary incision being made. The incision is approximately 2 mm below the eyelashes and can be extended laterally as necessary (top dashed line). It is made throug skin only. If one chooses to use a natural skin crease located more inferiorly for incision (lower dashed line), the incision must follow the crease as it tails off inferiorly. One should not use the lower incision and then extend the incision more superiorly as the lateral orbital rim is approached or the relaxed skin tension lines will be crossed,

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