Hard Palate Mucosal Graft and Bipedicled Tripier Flap as the Bilamellar Foundation for Extensive Lower Eyelid Defects: A Technical Note.

Extensive full-thickness lower-eyelid defects with canthal extension are shaped by posterior lamellar deficiency, canthal support, anterior lamellar height, and extension into adjacent facial subunits. This technical note describes a case-illustrated, defect-driven operative sequence after margin-controlled excision of basal cell carcinoma. In four selected cases, posterior support was restored with a hard palate mucosal graft and anterior lamellar coverage with a bipedicled Tripier flap. The bilamellar construct was used alone when tension-free coverage was possible. Regional flaps were added when residual anterior lamellar loss exceeded Tripier reach or extended into adjacent subunits: a superiorly based nasolabial flap in one lateral canthal defect and Mustardé cheek rotation with a glabellar flap in one medial canthal/nasal dorsum defect. All palatal grafts and Tripier flaps survived. These cases illustrate modular organization of established reconstructive components according to defect complexity, without proposing a universal algorithm.