It is, however, the opinion of most surgeons that this method has a higher incidence of failure with disappearance of the lid crease. This is an overly drastic maneuver without any added advantage while at the same time creating the risk of lid contour deformity and secondary ptosis. In the preliminary evaluation of these patients, it is important to elicit any history of wound-healing irregularity, keloid formation and hypertrophic scar, systemic illnesses, steroid intake, allergic blepharoconjunctivitis, keratitis sicca, and any contraindication to surgery. It is then transposed onto the skin side, which will constitute the new lid crease position. The lateral extent of the lid crease is made parallel or slightly higher than the central portion.
Any excessive skin is marked out in an elliptical fashion.
The author tries to stay within 8 mm from the lateral canthus. The epicanthal fold is left untouched in the majority of cases. The upper edge is pulled up slightly with a fine skin retractor, exposing the orbital septum, and again 2 mm of it is excised at its point of fusion with the distal levator aponeurosis. Postoperative swelling and ecchymosis are usually confined to the pretarsal portion of the lid incision and will recover in 4 weeks when the vascular and lymphatic channels reestablish themselves. Routinely the author advises patients to stop consuming any aspirin and anticoagulants for 2 weeks prior to and I week after the surgery.