Skin-muscle flap lower lid blepharoplasty: an easier dissection.

Most descriptions of the skin-muscle flap lower lid blepharoplasty, the so-called McIndoe technique, indicate dissection of the flap in a cephalad-to-caudad direction from near the ciliary margin toward the bony orbital rim. However, this report describes a technical variation in which counter-traction and lateral-to-medial blunt dissection "opens up" the potential anatomical space between the orbicularis oculi muscle and the tarsus and septum orbitale. This technique is easier and faster than the McIndoe procedure.