For lower lid defect of between 25 to 66 % of the horizontal dimension (Fig. 2a). The approximation will require either:

• lateral cantholysis of the inferior crus of the lateral canthal tendon (Fig. 2b)
• if lateral cantholysis insufficient, combined with a local periorbital skin and muscle flap (Tenzel's flap; Fig. 2c). The flap should be within the orbital rim otherwise incision through the thicker skin can leave prominent scarring.

	Figure 2a
	Figure 2b
	Figure 2c  Dotted line denote orbital rim

The above pictures show a woman who underwent a Tenzel's flap following excision of a basal cell carcinoma on her lid margin ( 2 day post-operative ).