Figure 1: (a) Initial presentation of basal cell carcinoma in an 89-year-old patient involving the right lower eyelid (thick arrow) and right upper eyelid (thin arrow). (b) After Moh’s resection, a large surgical wound measuring 5 cm by 2 cm involving 95% of the right lower eyelid and 60% of the right upper eyelid is present. (c) A periosteal flap was elevated from the lateral orbital rim and rotated medially to reconstruct the posterior lamella of the upper lid and provide an anchor for the lower lid. (d) A tarsoconjunctival flap was then harvested from the remaining superolateral tarsus of the right upper lid and rotated inferiorly to reconstruct the posterior lamella of the right lower eyelid (arrow). (e) Completed reconstruction with anterior lamellar full thickness skin graft from the left upper eyelid. (f) One year postoperative.