-: This is Richard Allen at oculosurg.com.
This video demonstrates one of many techniques
in the marking of an upper blepharoplasty.
The skin is cleaned with an alcohol swab
and a fine-tip marker is used.
The eyelid crease is first marked.
I will usually use the existing crease
or place it a little lower.
In general, a male's crease
should be about 6-8 millimeters
and a female's crease should be about
8-10 millimeters.
This of course is different in Asian patients.
In this case, the crease is placed
about 1 millimeter below the natural crease.
It is important to follow the contour of the existing crease
from the level of the punctum medially
to the lateral canthus laterally.
The marking is measured with calipers
and transferred to the contralateral side,
where the crease is marked again.
Asymmetrical creases should be noted
preoperatively if present.
Again, the crease is marked
and these markings should be symmetrical.
The redundant skin is then marked.
There are multiple ways to do this.
Currently, I mark the skinfold at the level
where it rests just above the lid crease marking
with the patient looking straight ahead.
This extends from the level of the punctum medially
and does not extend
outside the lateral orbital brim laterally.
The lateral lower marking is then connected
to the upper marking with a gentle upslope.
It can be difficult to mark the skin
medially with the redundancy,
and stretching it laterally allows marking.
This is then performed on the opposite side.
Again, this is just one way to mark.
Some surgeons use the pinch technique
or just measure from the brow.
I think it is important to ensure
that the same amount of skin is left on each side,
and this amount should measure
between 18-22 millimeters, depending on the patient.
Again, the area medially may be difficult
with the redundant skin.
After marking, I always measure
from the inferior brow cilia on each side
to ensure that the markings are symmetrical
and that enough skin will be left on each side.