The goal of lower eyelid blepharoplasty is to rejuvenate the lower lid while maintaining a natural, unoperated appearance. Successful lower eyelid blepharoplasty depends on knowledge of the anatomy and surgical techniques, accurate preoperative analysis, and attention to detail. Common issues of the lower eyelid such as malar descent, tear trough deformity, pseudoherniated fat, lid laxity, and skin texture changes as well as dermatochalasis and festoons must be recognized. Specific techniques to address these include transcutaneous and transconjunctival approaches, fat excision, fat transposition, orbicularis suspension, lateral canthal tightening, malar suspension, and skin excision/resurfacing.