The repair of full thickness defects of the lower eyelid varies based on the size, location, and configuration. The posterior lamella should be replaced with mucous membrane—namely conjunctiva, if available. The anterior lamella may be reconstructed with skin flaps or grafts. The goal of repair is to restore structure and function. A properly reconstructed eyelid should achieve comfort, reasonable cosmesis, and, importantly, protection of the ocular surface. This chapter describes a systematic approach to lower eyelid reconstruction.