Lower eyelid defects resulting from Mohs micrographic surgery can be challenging to repair. These repairs are fraught with potential complication due to the lower eyelid’s complex anatomy and defect variability. A single “cookie-cutter” treatment regimen does not exist because patients and defects vary. Surgical closure techniques include primary closure, eyelid advancement, rotational ﬂ aps, full thickness skin grafts, and/or allografts. We present a discussion of lower eyelid reconstruction including relevant anatomy, physical signs, and treatment options with examples.