Early on, it was believed that the formation of lid bags was the result of excess orbital fat and laxity of the lower lid skin. Recent studies suggest that the development of lid bags is the result of a disruption of the normal balance between the amount of orbital fat and the supporting structures of the lower lid. Laxity of the lower lid support structures, including the canthus tendon, the lid plate, the orbital septum, the orbicularis oculi muscle, and the skin, especially the orbicularis oculi muscle, which sags below the infraorbital rim, is often overlooked. Traditional blepharoplasty often only emphasizes the removal of skin and orbital fat, which often results in lower eyelid depression and deformity, recession and varying degrees of lid ectropion. Especially with age, the soft tissues in the orbital region and periorbital area gradually relax and sag orbital fat, whether excessive or normal, is herniated forward through the weak support structure of the lower eyelid; at the same time, periorbital bony markers such as the infraorbital rim are also gradually visible, showing old age. Therefore, even if the shape is good in the short term after surgery, it is not lasting and in the long term, it is easy to form oldness such as depression, recession, flaccidity, and so on. Therefore, how to restore the orbital fat and lower eyelid supporting structures and reset the original anatomical structure is the key to effectively correcting the deformity of bags under the eyes. Based on the Hamra procedure, we advocate the method of skin flap plus muscle flap, forming a thin skin flap and an independent orbicularis oculi muscle flap, as in the case of facial wrinkle reduction, because we believe that the skin and muscle of the lower eyelid have different degrees of laxity, which must be tightened separately, and at the same time avoiding the unevenness of the skin of the outer side of the eyelid after tightening. The superficial surface of the orbicularis oculi muscle is peeled to reach the lower edge of the sagging muscle, the muscle is pulled upward after freeing the lower edge of the muscle, and the septum is incised along the infraorbital rim. Orbital fat, which protrudes out to form a bag, is released through the incision, covered, and sutured to the periosteum slightly below the infraorbital rim in order to conceal the contour of the infraorbital rim (the Hamra procedure). Or a small amount of orbital fat may be removed and the septum and surrounding soft tissues are sutured and fixed to the periosteum of the infraorbital rim with 2-3 stitches; then the lower edge of the sagging orbicularis muscle is lifted up and reset to the level of the infraorbital rim and sutured and fixed. The patient is routinely asked to “open the mouth and eyes”, and a muscle with excess laxity or congenital thickening is cut parallel to the lid margin at the upper edge of the muscle flap, and a muscle is excised from the lateral canthus in a ‘V’ shape so that the muscle flap is lifted upward and outward at the same time, but only to keep the muscle flap at a slight tension or only flattened, further strengthening the orbital flap. Another key point of this procedure is to retain a muscle below the eyelashes, i.e., above the incision, for use in conjunction with the tightened orbicularis oris muscle flap to maintain complete continuity of the incised muscle. Most experienced plastic surgeons take care to avoid lid ectropion, but often overlook the difficult complication of lower lid recession. Lower lid recession is a downward displacement of the lower lid margin without ectropion, which is characterized by blunting of the outer canthus, excessive exposure of the sclera, and sad-looking eyes with symptoms of ocular irritation such as photophobia and tearing. Laxity of the lower eyelid horizontally or shortage of tissue vertically can lead to lower eyelid recession. In this procedure, the skin incision is extended outward and downward about 2 mm below the outer canthus joint to avoid blunting of the canthus; a muscle is preserved under the eyelashes to support the lower eyelid margin, keep it full and maintain the normal curve of the lower eyelid margin; orbital fat is preserved or removed in small amount to flatten and fix the orbital septum to prevent the septum and the lid capsule fascia below it from scarring and fusion; and at the same time, muscle flap lifting and tightening is performed to strengthen the infraorbital wall and the stricture step again. At the same time, the muscle flap was tightened to re-enforce the infraorbital wall and the hemostasis was tightened to prevent hematoma and mechanized scarring to avoid the occurrence of lower lid retraction. Restoration and fixation of the lower edge of the orbicularis oculi muscle and simple muscle flap tightening to the upper and upper outer side also play a role in the rejuvenation of the midface. Although this procedure has many steps and takes a long time to stop bleeding (about one hour for the same operator in the conventional procedure and two hours in this procedure), it is still a good method with safe and ideal results.