Fig. 13. A. Incisions are made at the upper eyelid crease and just above the central part of the brow. Dissection is carried from the upper eyelid crease to tarsus. The silicone rod is sutured to the tarsus with 5-0 Merseline. A Wright fascia needle is brought from the brow into the eyelid at the aponeurosis. B. The silicone is threaded through the needle and passed in a pentagonal fashion first medially and laterally, then brought out the upper middle brow incision. C. The ends of the silicone rods are passed through a 5-mm long silicone-tubing sleeve with a 1.5-mm lumen. The rods can be tightened within the sleeve to achieve the desired lid level. Nonabsorbable suture is tied around the sleeve to secure the rods, leaving a tail of the silicone rod on either side. Absorbable sutures are used to close the skin. (From Beard C. Ptosis. 3rd ed. Philadelphia: CV Mosby, 1981:181, Fig B, C, D.)