Upper eyelid incisions are made 8–10 mm above the lid margin. Ethnic eyelid creases are often 6 mm from the lid margin.
The lower eyelid incisions can be made as a transcutaneous skin only flap, transcutaneous skin muscle flap, or transconjunctival approach. The transcutaneous incision can be pinch excised or made 3 – 4 mm below the lash line. The transconjunctival approach is preferred by Dr. Barrera because it does not leave a visible scar. There is also less risk of ectropion or everting of the lower eyelid with this method, and it’s ideal for most patients with smooth skin and moderate fat pseudoherniation. The incision is made through the conjunctiva, and the orbital fat is removed. Dr. Barrera prefers to use CO2 laser skin resurfacing, a pinch technique to remove 2 – 3 mm of truly redundant skin, or a chemical peel to treat remaining dermatochalasis and superficial wrinkles.