BACKGROUND Basal cell carcinomas (BCCs) on the lower eyelid are not uncommon, and depending on their histological type, they can be highly aggressive and difficult to eradicate. Numerous techniques have been proposed for the reconstruction of the lower lid margin after surgical excision of the lesion. OBJECTIVE To describe a double-flap technique consisting of a mucosal and myocutaneous V-Y advancement flap to repair full-thickness lower lid margin defects in a one-stage procedure under local anesthesia. METHODS Over a 12-year period (1995-2007), 33 patients with BCC underwent lower eyelid reconstruction. After tumor excision, a triangular mucosal flap with a central pedicle was used to repair the inner layer. A similar triangular-shaped myocutaneous flap was obtained from the inferior orbicularis oculus muscle and sutured in a V-Y fashion to build the outer layer. RESULTS All 33 patients achieved satisfactory functional and cosmetic results. Slight scleral show and discrete rounded lower eyelid were the main adverse effects. No additional surgery was needed. CONCLUSION This double V-Y advancement flap is a simple, useful alternative procedure to close full-thickness defects in the lower lid margin. Aesthetic and functional outcome is good.© 2009 by the American Society for Dermatologic Surgery, Inc.