To reconstruct large lower eyelid defects that involve greater than 50% of the horizontal lower eyelid margin. ^{1 ,​ 2}

This approach offers reconstruction of wide defects of the lower eyelid with satisfactory cosmetic results and low morbidity at the donor site, and rebuilds the eyelid with its own tissue allowing restoration of normal anatomy and function. ^{1 ,​ 2}

Two-stage eyelid-sharing reconstructive technique: First stage involves (a) advancement of a tarsoconjunctival flap (Hughes flap) from the upper to the lower eyelid defect to reconstruct the posterior lamella (tarsus and conjunctiva) and (b) reconstruction of the anterior musculocutaneous lamella with a local flap, free full-thickness skin graft, or an advancement flap. During the first stage, the eye remains covered with the pedicle flap connecting the upper lid to the lower lid. This type of flap allows for new vasculature to form within and around the graft. The second stage is performed approximately 4 to 6 weeks later and involves severing the flap pedicle and re-creating the new lower lid margin. ^{1 ,​ 2}

This technique is indicated in patients with posterior lamellar defects (i.e., secondary to tumor excision or trauma) of the lower lid margin encompassing greater than 50% of the horizontal lid margin.

This procedure requires preservation of at least 4 mm of tarsal plate height in the upper lid (to prevent postoperative upper lid entropion, etc.) and is contraindicated in a patient with insufficient tarsus (i.e., in a patient who has had a prior surgery involving the tarsus).

Because this procedure requires the eye to be covered for several weeks before the second stage is performed, this surgery is contraindicated in patients requiring surgery in their only-seeing eye, or in children at risk for occlusion amblyopia.

Several factors should be evaluated prior to surgery: age of the patient; age of the wound; potential compromise to the vascular supply, such as active cigarette smoker or previous radiation treatment to the area, etc. Clinically, the size and orientation of the defect should be evaluated. Also, the upper lid should be everted to ensure that there is normal tarsal anatomy and no evidence of previous surgery involving the tarsus.