Sebaceous carcinoma is a malignant tumor that differentiates into sebaceous cells and is most common in the upper eyelid. The myotarsocutaneous flap（MTC flap）is a useful reconstruction method；however, there are several methods for pedicle selection, reduction of flap tension, and dealing with mucosal defects. It is necessary to understand the characteristics of each procedure. In this case, an MTC flap was used for full-thickness reconstruction of an upper eyelid defect after resection of a sebaceous carcinoma. The defect width of the upper eyelid was 48% of the entire eyelid width. The levator palpebra muscle and conjunctiva were elevated as the pedicle of the MTC flap. At the external canthus, the conjunctiva and upper crus of the external canthal tendon were dissected to advance the flap. The functional and cosmetic results were both satisfactory. At the end of the operation, the conjunctival defect was 6 mm in width；however, it healed naturally.
