Depending on the degree of necessary dissection, and patient comfort with local anesthetic only, the procedure may be done under local or regional block with or without sedation, or under general anesthesia or some variation of it. Marks are made with the patient upright, pinching just enough skin to allow closure of the lids without any remaining skin redundancy. The appropriate anesthesia is then administered, and the superficial eyelid tissues infiltrated with local. The previously marked skin is excised. Redundant muscle may be excised as well. The septum (membrane behind which the fat-pads are found) is either entirely opened, or opened at intervals. Fat from both eye-sockets is excised and compared for symmetry. The septum may be closed. At this point if the muscles elevating the eyes are to be repaired, this is performed. The skin and muscle is closed together on both sides.