Fig. 15. A. An incision is made in the upper eyelid crease, and dissection is carried down to tarsus. A rectangle of upper tarsus, levator aponeurosis, Muller's muscle, and conjunctiva to be excised is outlined. B. Scissors is used to excise the ellipse of tissue that was scored with a scalpel. C. Silk (7-0) is passed through the distal edge of the levator aponeurosis and brought partial thickness through tarsus and tied in an interrupted fashion. Eyelid crease sutures are placed between skin edges and tied. (From Smith B, Della Rocca R, Nesi F. Ophthalmic Plastic and Reconstructive Surgery. Vol 1. Philadelphia: CV Mosby, 1987:Fig. 30-27, A, B, C.)