ABSTRACT Background and Objectives: Reconstruction of periocular defects resulting after tumor excision is representing a great challenge especially if it involves more than a single zone. This study was done to evaluate the efficacy of bifid frontal superficial temporal artery island flap in reconstruction of complex periocular defects involving zones I, II and IV together. Patients and Methods: This study included 11 patients with combinations of zones I, II and IV periocular defects after excision of large basal cell carcinomas. All defects were reconstructed using a bifid island flap based on branches of the frontal division of the superficial temporal artery. Results and Conclusion: Apart from one flap, which developed distal necrosis, all flaps did well. All patients were satisfied to very satisfied about aesthetic and functional outcome. Bifid frontal superficial temporal artery island flap is considered a valuable and good option for reconstruction of periocular defects involving zones I, II and IV.