Supraorbital Eyebrow Approach
The “in the eyebrow” incision offers simple and rapid camouflaged access to the lateral supraorbital rim, the frontozygomatic suture line, and occasionally the region slightly below it. No important neurovascular structures are involved in this approach. If the incision is to be continued along the lateral orbit for more inferior exposure, the incision crosses the resting skin tension lines or crow’s feet perpendicularly; therefore, this option should be avoided. Additionally, cosmetic eyebrow removal restricts this incision for women. For these reasons, the supraorbital eyebrow approach is not recommended, except possibly for men whose fracture lines are high on the lateral orbital rim. The main disadvantages of the approach are the extremely limited access it provides and a scar that is perceptible within the eyebrow or, if extended inferiorly, below it.
A previously popular incision used to gain access to the superolateral orbital rim is the eyebrow incision. Apart from the advantage that this approach involves no important neurovascular structures, it gives simple and rapid access to the frontozygomatic area. If the incision is made almost entirely within the confines of the eyebrow, the scar is usually imperceptible. Occasionally, however, there is some hair loss, which makes the scar perceptible. Unfortunately, this approach is undesirable in individuals whose eyebrows are not extended laterally and inferiorly along the orbital margin. Incisions made along the lateral orbital rim outside the eyebrow are very conspicuous in such individuals, for whom another type of incision may be indicated. The main disadvantage of the approach is its extremely limited access.
▶ Step 1. Vasoconstriction
A local anesthetic along with a vasoconstrictor is injected into the subcutaneous tissues over the lateral orbital rim to aid in hemostasis.
▶ Step 2. Skin Incision
The eyebrow is not shaved. The skin is straddled over the orbital rim using two fingers, and an incision of 2 cm or longer is made, with the inferior extent of the incision arresting at the end of the eyebrow. The incision is made parallel to the hair of the eyebrow to avoid cutting the hair shafts. The incision is extended up to the depth of the periosteum (see Fig. 4.1). The skin is freely movable in this plane.