Answer: Barring any unusual circumstances for routine lower eyelid blepharoplasty, a canthoplasty is generally unnecessary. When a skin muscle flap is employed for a lower eyelid blepharoplasty, a lateral canthopexy may be utilized to secure the lower lid margin and prevent retraction or rounding of the lower lid margin. If a very young person presents with lower lid fat herniation with no skin redundancy, a transconjunctival blepharoplasty is usually indicated. In a middle aged person with skin redundancy, I prefer the use of a skin muscle flap. In most cases, I do perform a lateral canthopexy to secure the lid margin. One must be careful, however, in performing a lateral canthopexy to avoid lymphatic obstruction leading to chemosis (swelling of the conjunctiva).