Defect of 75 to 100% of the lower eyelid may be reconstructed using the following techniques:

• two-stage tarsoconjunctival flap proedure with full thickness skin graft (Hughes's flap):
• first stage is the creatio of a tarsoconjunctival flap, the horizontal incision

is parallel to the lid margin and at least 4 mm above the inner surface margin. After suturing the flap to the defect, the area is covered with a skin graft 
• second stage: 6 to 9 weeks after the first stage, the palpebral fissure is 

opened by dividing the flap and create a conjunctiva lined lid margin 

Figure 3b

• Mustarde cheek advancement flap with chondromucosal graft (obtained from the nasal septum). 

 

Figure 3c. The dotted line below the defect denotes the area for excision to  allow closure of the defect

• Tripier or bipedicle muscle flap with chondromucosal graft 

Figure 3d

Figure 3e