BACKGROUND Although several methods have been described for total lower eyelid reconstruction, it remains as a major challenge in reconstructive surgery. Here, we present a new technique, the Mutaf unequal Z-plasty procedure for reconstruction of defects of the lower eyelid. METHODS In this technique, 2 skin flaps designed in an unequal Z-plasty manner are used to provide skin coverage. Except for 2 patients whose additional upper eyelid defects were closed with Fricke flap, all patients were reconstructed with Mutaf unequal Z-plasty procedure. The conjunctival and tarsal defects are reconstructed with composite chondrocutaneous from the ear, mucochondral grafts, harvested from the nasal septum. In over 12 years, this new technique was used in 24 patients, 13 men and 11 women, with total and subtotal lower eyelid defects that resulted from excision of basal cell carcinomas. The age range of the patients was between 45 and 72 years. RESULTS There was no complication such as ocular irritation or postoperative epiphora because of ectropion or entropion; all patients healed uneventfully. A mean follow-up of 4.7 ± 2.15 years (between 1 and 9 years) revealed a functionally and cosmetically satisfactory total lower eyelid reconstruction in all patients. CONCLUSIONS This new technique seems to be a useful alternative for reconstruction of total and subtotal lower eyelid defects. The procedure seems to be superior since it requires considerably shorter operating time with no risk of flap failure. Moreover, this technique offers an excellent color and textural match for the reconstruction of total and subtotal lower eyelid defects extending the infraorbital area.