Cutaneous approaches to the lower lid and orbit.

In any discussion of surgical exposure, it is important to remember that of chief importance is what is done in the operative field, rather than how the site is exposed. Selection of approach is based on tradeoffs that must be weighed by the surgeon and tailored to the deformity for a given patient. Despite a recent surge in the popularity of the transconjunctival technique, periorbital surgery by a cutaneous approach is still a valid means of access for a variety of esthetic and particularly trauma procedures. There are few solid data comparing the two approaches, and what does exist shows little or no significant difference between them. A cutaneous approach spares the conjunctiva, bypasses transconjunctival-related complications, and eliminates the need for lateral canthotomy for access. The subtarsal lid crease incision appears to offer the benefits of the orbital rim incision with respect to speed, exposure, and low incidence of lid malposition, with cosmetic scar appearance that is comparable to the subciliary incision.