Objective      To determine the plastic outcome of lower blepharoplasty by modified myocutaneous flap and septum orbitale fixation.         Methods      A total of 312 patients undergoing plastic surgery for under-eye puffiness in our department from April 2003 to April 2008 were randomly divided into 2 groups

experimental group（group A）and control group (group B). In group A

patients were operated with following procedures in turn

incision design

make incision and free myocutaneous flap with skin flap superiorly

free muscle flap on the surface of septum orbitale

open and fix septum orbitale on the periosteum of infraorbital margin

muscle flap was also fixed to septum orbitale with te

nsion

then resect extra skin

fit and suture to close the wound. In group B

patients were operated with traditional myocutaneous flap lower blepharoplasty.        Results      Post-operative follow-up was made for 36 months. When compared with traditional myocutaneous flap lower blepharoplasty

our new technique had significant advantages

including long-lasting effectiveness on improving eye pouch

skin wrinkles and nasolacrimal groove

and preventing post-operative inferior eyelids depression (

P

<

0.01).        Conclusion      This modified lower blepharoplasty can reset lower eyelid anatomic structure

and provide natural

long-lasting effect. It is a modified surgical technique with much more indications

much less complications

and clear procedures.