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Laplant et al. Plast Aesthet Res 2020;7:60 I http://dx.doi.org/10.20517/2347-9264.2020.69 Page 5 of 12

Figure 5. A 5-0 plain gut suture is placed approximately 1.5 mm below the Putterman clamp along its entire width in a temporal to nasal
direction

Figure 6. A #15 surgical blade is used to excise the tissue by cutting between the suture and the clamp

Figure 7. The suture is then passed in a running fashion from the nasal to temporal direction, burying the knot under the conjunctiva at
the end

within the clamp is removed using a No. 15 blade avoiding the sutures [Figure 6]. The suture is then passed
in a running fashion from nasal to temporal direction, burying the knot under the conjunctiva at the end
[Figure 7]. Alternatively, the suture may be passed from the nasal to temporal direction with the clamp still
attached and the excess conjunctiva and Muller’s muscle removed with Wescott scissors [Figure 8]. Either
single or double armed 6-0 or 5-0 plain gut sutures can be utilized. If using a single needle, the suture is
passed through full thickness eyelid skin, run medially and then back laterally and externalized adjacent