Step 8 Periosteal Incision

Once the skin/muscle flap of tissue is elevated from the lower eyelid, it can be retracted inferiorly, extending below the inferior orbital rim. If no violation of the orbital septum occurred, one should see the tarsal plate above with the pretarsal portion of orbicularis oculi still attached, and the orbital septum below extending to the infraorbital rim. An incision through the periosteum on the anterior surface of the maxilla and zygoma, 2 to 3 mm below or lateral the orbital rim, can be made with a scalpel (Fig. 2-21). The incision through the periosteum at this level avoids the insertion of the orbital septum along the orbital margin. The infraorbital nerve is approximately 5 to 7 mm inferior

Figure 2-21 Incision through periosteum along anterior maxilla, 3 to 4 mm inferior to infraorbital rim. Note the pretarsal muscle still remaining on the inferior tarsus and the orbital septum, which restricts the orbital fat from entering the field.

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