For anterior lamellar defects: full-thickness skin graft from upper or lower eyelid, posterior auricular, preauricular, or supraclavicular skin

For posterior lamellar defects: palatal mucosa, auricular cartilage, and tarsoconjunctival grafts are the gold standard

Resilience and high vascularization

Effective conjunctival replacements

Less immune response

Corneal irritation due to absence of goblet cells and a rough surface

Lack of rigidity compared to a native tarsal plate

Painful and increased post-op healing period

Limited donor area availability

Full-thickness cutaneo-conjunctival lower eyelid bridge flap over the upper eyelid, separated a few weeks later

No material needed

Usable for most defects

Effective for large eyelid defects

Can be combined with a graft to promote greater stability

Entropion

Lid margin irregularity

Eyelash loss

Bridge flap necrosis

Eyelid retraction

Eyesight problems for people with low visual acuity on the unoperated eye

A rhomboid-shaped defect is created, consisting of two triangles placed base to base

No material needed

Minimal complications

Useful in challenging medial canthal defect

Low traction on the skin

Flap can be rotated in multiple directions

Stress unevenly distributed

Modification in canthal height

First incision made at the lateral canthus all the way up at the level of the eyebrows

Second incision vertical to the tragus

Minimal skin tension

Useful for large defects

Can be combined with a posterior lamellar graft

Good cosmetic result, low complication rate and low patient morbidity

Downward contraction and sagging of the flap

Ectropion

Need of a septal cartilage mucoperichondrial autograft to reproduce the tarsus

Musculocutaneous bipedicle flap from the upper eyelid suspended at both canthi not including the tarsal plate

With or without septal cartilage graft

Considered one of the best to repair lower-lid retraction or ectropion

Good aesthetic and functional results, with excellent color match

Low complication rate

Less damage to the facial nerve

Preserve the continuity of orbicularis muscle fibers

Ectropion

Epiphora

Eyelid edema

Lagophthalmos

Dry eyes

Tarsoconjunctival flap from upper eyelid, split at the mucocutaneous junction and attached to the lower lid conjunctiva

Flap is Separated few weeks later

With or without a skin graft

Best used for full-thickness defects of the central portion of the lower lid

Good functional and aesthetic results

Low complication rate

Lower lid margin erythema

Lower lid ectropion or entropion

Lagophthalmos

Infection or flap dehiscence

Eyelid retraction

Dry eyes

Corneal abrasion