AIM: To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid. METHODS: Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis. A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect. The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft. Postoperative cosmetic and functional outcomes were evaluated. RESULTS: The mean age of the patients was 46.3±18.1y (20-70y). The defects ranged from 30%-80% of the lid width and resulted from the excision of lid tumors in 11 patients (55%) and from trauma in 9 (45%) patients. Postoperative complications included one case of lateral graft ectropion, 2 cases of lid retraction and 3 cases of marginal graft necrosis. Most of the patients had an acceptable final cosmetic outcome. CONCLUSION: Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction. Large defects ≥50% of the horizontal length are at greater risk of complications. Reconstruction of medial defects by this technique was associated with a greater incidence of complications.