BACKGROUND To compare the functional and cosmetic outcome of pediculated versus free anterior and posterior lamella reconstruction after large eyelid defects due to malignancy excision. PATIENTS AND METHODS A retrospective study over 2 years with 12 patients matching the criterion of pediculated versus non-pediculated transplants out of a cohort of 124 tumor excisions. The mean age was 76 ± 8 years of the 7 male and 5 female patients. In the majority of cases, more than half of the eyelid was excised. The posterior lamella was always reconstructed with tarsal tissue, and the anterior lamella mostly with an upper eyelid skin graft. The postoperative follow-up time was between 2 months and 1 year. RESULTS Nodular basal cell carcinoma was the prevailing histology (6 patients). The reconstruction techniques included a Hughes procedure (four patients) or a free tarsal graft with a pediculated skin flap (four patients), respectively. In the remaining four patients, a combination of pediculated/free anterior AND posterior lamellae was performed. Four patients had a one-stage and eight patients a 2nd stage procedure with a mean time until tarsoconjunctival flap reopening of 16 ± 2 days. CONCLUSIONS No difference was found in the final functional outcome in pediculted versus free grafts. The cosmetic result was better in anterior lamella reconstructions with a pediculated flap, which usually allows a one-stage procedure. The 2nd stage procedure could be performed after 2 weeks without any complications.