Conventional lower lid blepharoplasty techniques emphasize the removal of excess skin and fatty bulges of the lower eyelid. The appearance is improved at the expense of lateral pretarsal flatness associated with the senile eyelid. Augmentation blepharoplasty is a modified technique for a lower lid blepharoplasty using an overlapping orbicularis oculi muscle repair to increase pretarsal fullness, which is associated with the youthful lower eyelid. The technique was used successfully in 30 consecutive, unselected patients, and this experience is reviewed in detail. The technique, surgical anatomy, and complications are outlined. The results prove this technique to be a safe method of lower lid blepharoplasty that does not interfere with the additional goals of periorbital fat and excess skin removal.