Subciliary lower eyelid blepharoplasty has evolved to achieve a more harmonious, natural appearance with a fuller, unoperated look, while minimizing complications. Whereas lower eyelid malposition was once common, its incidence has been markedly reduced through careful preoperative evaluation, meticulous surgical planning, precise technique, and attentive postoperative care. Prophylactic maneuvers that maintain or reinforce lower lid support include preservation of the pretarsal orbicularis oculi muscle, conservative skin and muscle resection, and suspension of the orbicularis oculi muscle and/or tarsus to the periosteum of the lateral orbital rim. Releasing the orbicularis retaining ligament and transposing orbital fat over the rim, rather than excising it, smooths the lid–cheek junction, corrects the tear trough deformity, and reduces the appearance of lower eyelid fat prolapse. This presentation outlines a comprehensive approach to achieving a smooth lid–cheek transition while preserving or restoring lower lid support and provides detailed postoperative guidelines to optimize recovery.