Small-incision techniques in ophthalmic plastic surgery.

A stepped surgical incision, in which an initial small cutaneous incision is followed by progressively longer incisions in the subcutaneous tissues, limits postoperative scar formation in the skin. Placement of incisions parallel to relaxed skin-tension lines further reduces the size of the scar. We describe how these principles may be applied to ophthalmic plastic surgical procedures to improve cosmesis. Autogenous fascia lata can be harvested with scissors through a 15-mm incision parallel to relaxed skin-tension lines, placed over the middle of the iliotibial tract. Lacrimal bypass operations can be performed well and with good cosmesis through a 12 to 15-mm skin wound if the above principles are followed.