ANDREA TOOLEY, MD: So we're just making our upper lid incision here with a 15 blade. So the same thing here, making our incision in our lower lid crease to start. After we make our incision, we'll take off the upper eyelid skin and orbicularis.

So now we use monopolar cautery to cauterize our incision. So you can see this nice bed here. It's basically almost all still orbicularis. So I will go in and take a little strip of orbic again. I'm going to go ahead and target that nasal fat pad now and remove some of that [INAUDIBLE] bulk for him.

The nasal fat pad's pretty sensitive, and so I do tend to give it a little extra local. We're going to excise this nasal fat pad here. And I just use a combination of cut and coag on the cautery to excise it. It can be vascular, and you don't want any bleeding post-septal in the orbit.

Right. I'm just going to take off that little strip of orbic centrally. So we're going to target that nasal fat pad over here again. Great. All right. So we're going to flip the lid, but we're going to mark it in three spots-- nasal, central, and lateral. Now we're going to place our silk traction suture.

So now we have our three loops on each side. And those are going to be our three tractions. What I want to do is I want to come over, and you want to center this on the tarsus. Nice. Then we just lock that in place. So now I just cut the loops.

So I'm going to start my suture up in the lid. And I'm going to exit posterior to the clamp, lateral or medial. It doesn't really matter because I like to go back and forth. OK. So now we forehand and backhand it and we weave it across the lid, so this is kind of a trickier part.

So then I do my resection. And you don't want to cut your suture. So you just aim up and metal on metal the whole way across. So now I like to close the conj You definitely don't have to close the conj but I feel like it helps with hemostasis. So now we enter in our incision, and we'll externalize our needle.

So the same thing over here. We're just going to mark the lid nasally, centrally, and laterally. And same exact thing. We're going to come down over, and we want it centered on our tarsus. And I like the look of that very much. And we're just going to do the same thing we did on the other side. Right under our clamp and then we'll do our resection.

And now we'll weave it back and close the conj so that our wound is closed. We'll go into our wound and come out close to where we entered. All right we're going to close the lids now.