Eyelid reconstruction series, post 5: complicated reconstruction of a recurrent squamous cell carcinoma that extended into the orbit. This man had a prior squamous cell carcinoma in the same region that was removed and repaired with a paramedian forehead flap. When the tumor returned, it had extended into his orbital septum, and a major reconstructive option had already been exhausted. After complete removal of the tumor with Mohs micrographic surgery and stripping of the periosteum around his orbital rim/eye socket, his lacrimal/tear drainage system was repaired and a large rotation flap was moved into place and anchored to bone. This upward tension vector and solid anchor allowed excellent support and restoration of his lower eyelid, with both an excellent functional and cosmetic outcome!