Fig. 4

Incisional planes for harvesting a Hughes tarsoconjunctival flap. a. Incision of the classical Hughes procedure (arrow) starting at the grey line of the lid margin, leaving the levator muscle aponeurosis and Müller’s muscle attached to the tarsal plate. b Currently, the most widely used incisional plane spares 4 mm of the marginal tarsus. Levator and Müller’s muscle attachments are completely separated from the tarsus leaving only a thin solely conjunctival pedicle. c Incisional plane used in the present study. While disinserting the levator aponeurosis from the tarsus, Müller’s muscle insertions are left attached to the superior tarsal border