=Tripier Method.=—For the restoration of an entire lid the method of Tripier is to be advocated. A bridge flap with both ends attached is taken from the healthy eyelid (Fig. 101). It is obtained by making the curved inferior incision in a line with the superior border of the tarsal cartilage, and the superior incision parallel to the first at a distance depending upon the size of the defect to be covered. The flap thus formed should include some of the fibers of the orbicularis muscles detached from the tarsal cartilage, making it really musculo-cutaneous. [Illustration: FIG. 101. FIG. 102. FIG. 103. TRIPIER METHOD.] This bridge or musculo-cutaneous flap, attached at both ends, is then gently drawn forward with a tenaculum and slid downward over the upper lid upon the defect of the lower lid, and there retained by interrupted silk sutures (Fig. 102), the superior margin of the bridge flap being sutured to the conjunctival fold freed by the previous extirpation of the lower lid. The retention of the fibers of the orbicularis palpebrarum in the flap covering the defects is intended to take the place of the part of muscle destroyed by the incision of the faulty tissue in the lower lid, and enables the patient to open and close the lid almost as well as in the normal state. The margins of the wound made by the removal of the flap are snugly brought together and heal without the least discomfort to the patient, inasmuch as the skin covering the lid is quite loose and elastic (Fig. 103). =Von Artha Method.=—It sometimes happens that by the extirpation of tumors part of both eyelids has to be removed. To restore such defect the following method may be followed: Two sickle-shaped flaps are raised from the skin bordering the outer margins of the primary incision, according to Von Artha, and sliding them about so as to reform the canthus of the palpebral fissure (Figs. 104 and 105). [Illustration: FIG. 104. FIG. 105. VON ARTHA METHOD.] This method leaves little if any secondary effect, its immediate success depending upon the preservance of the conjunctiva at the time of extirpation. As will be seen, the foregoing method only included operations about the lower lid. The majority of these operations are required only for the lower lid; where defects of the upper lid are to be corrected the flaps and incisions mentioned must be made to correspond to the defect, while in the V-Y method the incision must be inverted. ECTROPION OF BOTH LIDS In the case of ectropion of both lids the palpebral tissue may be sutured for a period of several months with certain benefit, if no other operations can be decided upon. Or the method may be combined with any other plastic operation deemed serviceable for its correction. In most defects of the upper lid, however, if they are not too extensive, the loose skin of the lid itself can be utilized by sliding flap methods to cover the defect (Kolle). EPICANTHUS