Options for periorbital reconstruction include primary wound closure, local flaps, regional/distant flaps, or full-thickness skin grafts. Optimal aesthetic and functional outcomes are achieved by assessing regional contours, skin type, and facial aesthetic units. Like tissue should replace like tissue; for example, skin with skin, tarsus with tarsus (or equivalent material, eg, hard palate, ear cartilage, or autologous substitute), and conjunctiva with mucous membrane or like substitute (buccal mucous membrane, amniotic membrane). Patient characteristics including wound care needs, transportation needs, smoking status, and history of radiation can influence the reconstruction plan. Techniques most commonly used in our practice are reviewed.