=Instruments.= Scalpel, dissecting and artery forceps, scissors, sutures. =Operation.= The operation is performed under a general anæsthetic. _First step._ An oblique incision (Fig. 156), starting from below the inner end of the deformity, A, is carried outwards and slightly upwards for 12 mm. to the point B. From the point B a curved incision B C is carried upwards to and along the orbital margin. This marks out a triangular flap. From C the incision is carried outwards and downwards in a curved direction to D, which is situated about 2 cm. from the external canthus, thus marking out another triangular flap B C D. _Second step._ Both flaps are dissected up, and, when all bleeding has ceased, the apices of the triangles are transposed and sutured in position, the incision thus forming a _Z_-like figure (Fig. 157). A canthorrhaphy is generally required. =Fricke’s operation.= This has for its object the transplantation of flaps from the side of the forehead or face into the lid to remedy a loss of tissue resulting from operation or cicatricial contraction. =Indications.= The operation is usually performed for cicatrices about the upper lid, the flap being turned down from the side of the forehead. A flap may be turned in from the inner side in addition if necessary. The operation may also be applied to ectropion of the lower lid. =Operation.= When planning the flaps the following points must be taken into account:-- (i) The flap must be cut so that its base contains the main blood-supply of the part made use of. (ii) It should be at least one-third larger than the area to be covered. This is estimated by cutting a piece of protective the size of the area to be covered and laying it on the skin before the flap is cut. [Illustration: FIG. 158. FRICKE’S OPERATION. To replace the loss of portions of the skin of the upper lid.] (iii) The base of the flap should consist of a considerable amount of subcutaneous tissue as well as skin, but the apex may be little more than the skin itself. (iv) The direction of the subsequent contraction should be taken into account so as to assist the final result. _First step._ The lid is first freed by dividing all the cicatricial bands, or, if only a small cicatrix be present, by excising that. The lid is then pulled down into position and put fully on the stretch. This is best performed by stitching the margin of the lid to the cheek. _Second step._ The flap is marked out at least one-third larger than the size required to cover the raw area. The base of the flap should be placed a little below the raw area to be covered, so that the rotation of the flap into position is easily performed without danger of constriction to the base (Fig. 158).