Aging changes in the lower eyelid occur variably in each patient: tear trough deformity, orbital fat prolapse, loss of skin elasticity, or orbicularis prominence. A customized approach considering each patient’s lower eyelid configuration is important. Surgical procedures for lower blepharoplasty include the transcutaneous approach and the transconjunctival approach. Fat can be removed or repositioned into depressed region. The lower eyelids have several particularly subtle anatomical and functional considerations that the careful surgeon must consider to select the appropriate approach. Overlooking small variations in anatomy and function can lead to suboptimal outcomes or complications in lower eyelid surgery. Proper planning and exact execution are essential to have a good surgical outcome in performing lower blepharoplasty.