Retraction and ectropion of the medial lower eyelid leads to exposure keratopathy, epiphora, and cosmetic deformity. In repairing lower lid ectropion, it is often the medial part which is resistant to correction. Procedures to address this problem include the Lazy T, Lee's Medial Canthoplasty, Medial Canthal Resection, Medial canthal tendon plication, Medial Tarsal Suspension, as well as grafts to the anterior and posterior lamellae. Several of these procedures were described by, or in collaboration with, members of the Australian and New Zealand Society of Ophthalmic Plastic Surgeons. An outline of various commonly used procedures will be presented, together with their strengths and weaknesses.