This chapter describes rectus muscle-tightening procedures: the rectus muscle resection and the Wright rectus muscle plication. The rectus plication can be a full muscle plication or a partial central tendon plication. The Wright central plication is covered in Chap. 22 . Recently, many surgeons have switched to Wright rectus plication because it is fast, the muscle is not cut avoiding the complication of a lost muscle, and it is semireversible and is vessel sparing.