This Richard Allen at the University of Iowa. This video demonstrates the use of a glabellar flap to close a medial canthal defect. In general, these flaps are most useful for medial canthal defects that are superior to the medial canthal tendon. A 15 blade is used to make an incision through the skin and subcutaneous fat. In general the design of the flap should be larger than what you think will close the defect. Dissection is then carried out in a plane beneath the subcutaneous fat. The flap is then mobilized. Wide undermining is then carried out at the donor region of the flap. Closure of the donor site results in the correct positioning of the flap into the defect. The donor site is then closed with interrupted 4-0 Vicryl sutures placed in a buried interrupted fashion. Additional sutures are then used to place the flap in position. This is performed with buried interrupted 5-0 Vicryl sutures. The flap is then thinned in the area where the thicker glabellar skin will be adjacent to the thinner eyelid skin. This is performed with Westcott scissors which are hopefully sharper than the ones I am using here. The skin is then closed with 6-0 prolene sutures at the eyelid skin and 5-0 prolene sutures at the area of the donor site.