About 30 minutes prior to the procedure, the patient is premedicated with alprazolam (Xanax; Upjohn Inc, Kalamazoo, Mich), 1 mg, the combination drug propoxyphene napsylate (100 mg)–acetaminophen (650 mg) (Darvocet N-100; Purepac Pharmaceutical Co, Elizabeth, NJ), 1 tablet, and cephalexin, 500 mg. While waiting for the medication to take effect, the eyelid is marked for the incisions with the patient in a sitting position. A surgical loupe is used for magnification. A fine-point, felt-tipped pen is used to draw the line. With the patient's eye closed, the eyebrow is gently lifted to stretch the eyelid skin. Using a caliper for measurement, a dot is placed at about 6 to 7 mm from the ciliary margin. While the eyelid is stretched, a line is drawn medially and laterally to the extent of the palpebral fissure parallel to the tarsal margin. In the medial canthal area, the line continues when the Z-epicanthoplasty1 is necessary (unpublished data, 1998). The patient is then allowed to open the eyes to reveal the marking. When the eyes are open, the marking usually ends up at the level of the tarsal margin. The laxity of the eyelid skin will determine, to a great extent, how much skin is going to fold over the new crease. The eyelid with lax skin will have a marking right at the tarsal margin when the eyes are open. The eyelid with tight skin will have this line somewhat higher, still only about 1 mm from the ciliary margin. A broken wooden Q-tip is used to gently retract this marking against the tarsus in a superior direction to simulate the surgical result. This will allow the surgeon to estimate the height of the double fold. Only a single line is needed for preteens or patients in their early 20s with tight eyelid skin. For the eyelid with redundancy, often found in patients older than 30 years, the elliptical area of skin is marked for excision.