Results of aesthetic lower eyelid surgery have improved through a better un
derstanding of the anatomy, indications for surgery, and more effective, in
dividualized solutions for the varied problems, Most treatment options have
the potential risk of inducing lower eyelid malposition if support is not
applied through either canthoplasty or canthopexy. An algorithm for selecti
ng the most appropriate method of canthal support in lower eyelid and midfa
cial rejuvenation is presented. A new, simplified, effective, and aesthetic
suture canthopexy, the transpalpebral lateral retinacular suspension, is i
ntroduced; it can be universally applied.