Lower eyelid defects are traditionally classified based on depth and 25 percent increments in defect width.

The authors propose a new classification system that includes the vertical defect component to predict functional and aesthetic outcomes.

 A retrospective review of patients who underwent lower lid reconstruction performed by a single surgeon was performed.

Defects were classified into four categories based on the vertical component: (1) pretarsal; (2) preseptal; (3) eyelid-cheek junction; and (4) complex pretarsal/preseptal.

Preoperative and postoperative central and lateral marginal reflex distance-2 values were obtained.

Aesthetic outcomes were evaluated by three blinded reviewers. Outcomes were compared using one-way analysis of variance and analysis of covariance with Bonferroni corrected post hoc comparisons to control for defect area and width.