As the lower eyelid is frequently the site of malignant disease, lower lid replacement is a common task in oculoplastic surgery. As a rule the reconstruction of larger defects (more than one-third) can be accomplished with free grafts or with flaps. Different forms of pedicle flaps (full thickness, tarsoconjunctival, combined) from the upper lid provide better results than free grafts. A convenient method of lower lid replacement is the use of a medial pedicle rotation flap of the cheek. This has advantages over the temporal pedicle cheek flap or the frontal flap.