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. After performing an upper eyelid blepharoplasty, but before closing the skin, the forehead is undermined under the layer (periosteum) covering the skull bones. Adequate release is assured by elevating the skin and witnessing re-positioning of the eyebrows in a symmetric fashion. A drill is used to make two symmetric holes to either side of the midline in the calvarium that extend only partially through the skull. This is assured by using a manual drill with a stopper. Two symmetric drill holes are made in the outer portion of the skull. The TransBleph fixation devices are deployed. They look like plastic hang-hooks. The skin is re-draped over the hooks in the desired position. 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. A compressive dressing is then applied to allow the forehead soft tissues to scar in the appropriate position.