In an effort to prevent post-operative eyelid complications, lower blepharoplasty requires taut approximation of the lower lid to the globe. This is routinely accomplished with lid tightening procedures and/or canthal fixation. Multiple techniques can be utilized in combination to appropriately and aesthetically reposition the lower eyelid during cosmetic blepharoplasty. These techniques include simple canthopexy, canthoplasty, drill hole fixation, and complete tarsoligamentous sling reconstruction. In this article, we examine the unique anatomy of the lateral canthus as well as the indications for utilizing diverse options for canthal fixation.