The eyelids extend from the eyelid margins to involve all the skin within the orbital rim. In reconstructing the eyelids, both the functional and cosmetic aspects must carefully be taken into consideration. Symmetry is paramount in achieving optimal cosmetic results. Of equal or greater importance is the functional restoration of the eyelid. The sphincter action of the orbicularis oculi muscle needs to be preserved for normal opening and closing of the eyelids. Furthermore, vector tensions on the lower eyelid must be carefully considered in order to prevent ectropia.

The anatomy and reconstruction of the eyelid can be quite complex.

There are, however, few important points that can simplify this process.

• Reapproximate each anatomic structure, for example, tarsus, orbicularis, lid margin.

• Design flaps that give an upward tension vector on the lower lid.

• Oversize grafts and flaps for the lower lid.

• Generally, align linear closures in a more vertical orientation, perpendicular to the lower-eyelid margin.