Over the course of my career, I (F.X.P.) have used many different techniques to reconstruct the lower eyelid (1, 2, 3, 4). Some of these techniques include (1) the nasolabial flap, (2) the upper eyelid skin flap, (3) the supraorbital skin flap, (4) the midforehead skin flap, (5) the cervical tube skin flap, (6) the full-thickness skin flap, and (7) the Hughes procedure (Fig. 21.1). I have found each of these procedures to be successful (5, 6, 7, 8). Some are obviously more appropriate in selected patients. Donor site morbidity and scarring are often determining factors in technique selection.

When I first used the nasolabial skin flap for lower eyelid reconstruction, I felt that it would be necessary to perform secondary procedures such as an additional mucous membrane graft for lining (9), a fascial sling for support, and
reconstruction of the lacrimal apparatus for tear drainage. Follow-up on these patients, however, has demonstrated that additional procedures are rarely necessary.