The lower lid cheek junction is a complex region. Patients are concerned about contour deformities of the lower eyelid and the cheek, but the causes of these issues are found in the underlying anatomy. Age-related bony changes result in a recessed infraorbital rim and a recessed maxilla. Loss of cheek soft tissue contributes to the formation of a tear trough deformity. Configuration of the tear trough comes in 3 classes, each of which requires a different surgical treatment. Combined procedures on the lower lid and the cheek often result in the most significant improvement.