Step 4 Skin Incision

The incision for a subciliary approach is made approximately 2 mm inferior to the lashes, along the entire length of the lid (Fig. 2-13). The incision may be extended laterally approximately 1 to 1,5 cm in a natural crease if more exposure is necessary (see subsequent text). If no natural skin crease extends laterally from the lateral palpebral fissure, the extension can usually be made straight laterally or slightly inferolaterally.

The depth of the inicial incision is through the skin only. One should see the underlying

Figure 2-14 Subcutaneous dissection of skin, leaving pretarsal portion of orbicularis muscle attached to the tarsus. Dissection 4 to 6 mm inferiorly in this plane is adequate.

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