Cosmetically favorable scars using the upper blepharoplasty incision.

To the Editor: Approaches to the craniofacial skeleton have been developed to provide good surgical access and to obtain cosmetically favorable scars. The zygomatic complex and the orbit present a significant concern for postoperative scars because of their prominent visibility on the face. A zygomaticomaxillary orbital complex fracture may require exposure of the zygomatic buttress through the buccal sulcus (Keen) approach, infraorbital rim by the subciliary or transconjunctival approach, and the zygomaticofrontal region by either the upper blepharoplasty or lateral brow approach. The lateral brow incision design provides relatively quick and direct access to the lateral orbital rim of the zygomatic complex. The incision is made parallel to the hair follicles within a lateral brow line to minimize postoperative scarring. A disadvantage of this technique is a visible scar if extended past the brow and more visibility if the patient has a thin or absent eyebrow. The upper blepharoplasty incision is not commonly described for access to the zygomaticofrontal region. This approach provides similar exposure compared to the lateral brow incision, but with the advantage of having a camouflaged scar similar to that obtained with a blepharoplasty. The upper blepharoplasty incision is placed in the upper eyelid skin fold, 8 to 10 mm superior to the lid margin (Figs 1 and 2). The incision is approximately 2 cm in length, which provides adequate exposure of the frontozygomatic region (Fig 3). Blunt dissection