BACKGROUND: The seventh nerve palsy causes loss of function in the affected orbicularis oculi muscle. There is exposure and dessication of the corneal surface and obvious aesthetic changes in facial symmetry. METHOD: A surgical procedure has been used in 11 patients to substantially improve palpebral closure. The technique consists of a small upper lid tarsoconjunctival flap sutured into a nasal pretarsal pocket of the lower lid, achieving a medial tarsal suspension of the lower lid. RESULTS: This technique improves cosmesis, is reversible, and combinable with other procedures. The signs and symptoms of exposure keratitis are satisfactorily resolved. There have been no complications in an average follow up of 5 1/2 years after this surgical procedure. CONCLUSION: This technique could be considered an appropriate treatment for patients suffering temporary or permanent facial palsy.