Cicatricial ectropion occurs when the eyelid is abnormally rotated outward due to shortening of the eyelid or midface skin. This eyelid malposition causes exposure of the ocular surface that can result in irritation, corneal dryness, conjunctival injection, and other visual complaints. Treatment typically involves replacement or recruitment of skin combined with lateral canthal anchoring procedures. This chapter describes lower eyelid ectropion repair with a skin graft.