 So hi everyone, Dr. Saul here. We're doing a quad left that needs four uppers and lowers four of them So you can see I've already marked the patient But as you can see using the caliber I'm seeing the distance from the eyelid to the incision mark is about nine millimeters Here it's nine millimeters exactly and the area where we're taking out skin is about nine and Nine we don't want to take too much. We don't want his eyebrows down on his eyes The other thing is we're doing the lowers. You can see he has fat pockets here We're going to take out the fat pockets and going to pull up Pull up the skin a bit like this to make this nice and clean. It's going to be a great case He's a very good candidate. He's already sedated. He's ready to go So this is the medial not middle but medial fat you could see it's a very It's on a pedicle. It can be used as Maneuvering over but he doesn't need it. He has fullness. So what we're going to do. We're just going to take it out It's a very small amount, but sometimes it could cause bulging in the upper eyelid So here's the corresponding side of left side, which is again the medial pocket which we dissected out and Very easily it's a small amount, but it makes a difference because it's a small area So here's his lateral. This is the lateral eye temporal area his fat So we're going to take that out so it doesn't bulge out. That's it right there And we're just going to boom boom and boom there it is small amount But it makes a big difference in a small area So this is the medial not middle, but the medial aspect of the lower eyelid So we got that one too. So we got all three Components so what we're going to do is called a canthopexy What a canthopexy does it tightens the lower eyelid? I'm just going to put a suture in from here Bring it out the other side With this suture you could see I can control the lower eyelid You see that so what I'm right right there the iron the The lower eyelid is controlled with this suture and I'm going to fixate this suture So that he doesn't get any Entropion or anything. It's a tacking suture