Many surgeries for lower eyelid retraction (LLR) are invasive and incomplete. In this video, the authors describe a lateral tarsoconjunctival suspension flap (LTSF) for LLR and review a large retrospective series. Charts of patients treated with a LTSF between 2018 and 2023 were abstracted for indications, results and complications. Various lower eyelid retraction etiologies were identified: facial nerve paresis (n = 47), cicatricial (73), involutional (34) and negative vector (96). LTSF was often an adjunct to other procedures, most commonly horizontal tightening. The results were very favorable, with improvement in retraction and ocular exposure in all cases. Complications included pyogenic granuloma (4.4%), overcorrection (2.8%), undercorrection (3.6%) and infection (2%). All were treated with conservative measures or minor revision. In this large series of LLR due to various causes, LTSF was safe and effective.