Upper eyelid skin and muscle resection

This is a basic surgical maneuver in most upper eyelid blepharoplasties of almost any kind, whenever there exists a fold or crease at the upper eyelid due to the excess of skin and orbicularis oculi muscle preseptal portion.

Marking of the island to be excised begins by its lower edge with finding the tarsal crease where the levator palpebrae superioris muscle inserts into the skin, then the lateral extension of the island to remove the side excess or dog ear is marked within the most continuous muscular wrinkle at crow's fee area; this is accomplished by making the eye follow a visual point so that the eyelid outlines the aforementioned upper tarsal crease; this makes possible the best aesthetic quality of scars, their concealed location and prevents any functional retraction.

Then comes a very delicate stage to mark the upper edge of the removed island, which is a very personal experience based decision for the surgeon; it is best decided by marking the correspondence at the upper eyelid of the lower edge of the island line in a frontal and neutral eye vision position and without any bias due to forehead or eyebrow elevation contraction; also the outer side crease is marked in a smooth and sinusoid contour, making the final island be like the silhouette of a whale; deciding the amount of skin to be removed is critical to prevent over resection leading to eyelid closure limitation or under resection with insufficient aesthetic benefits.