Aims: To evaluate the safety and efficacy of a lateral tarsoconjunctival onlay flap procedure in correcting multi‑vector lower eyelid retraction. Settings and Design: A retrospective chart review of patients treated with a lateral tarsoconjunctival onlay flap procedure for lower eyelid retraction between 2008 and 2013. Subjects and Methods: Inclusion criteria were adult patients with multi‑vector lower eyelid retraction who underwent a lateral tarsoconjunctival onlay flap procedure. Pre‑ and post‑operative symptoms, ophthalmologic biomicroscopic findings, eyelid position, complications, and subsequent treatments were recorded. Results: A total of 147 eyelids from 131 patients were included. Exposure symptoms such as irritation, epiphora, photosensitivity, and glare improved in all patients. Signs secondary to abnormal eyelid position such as lagophthalmos, ocular surface exposure, exposure keratopathy, and eyelid retraction (both upper and lower) improved in all cases. Complications were rare but included pyogenic granuloma (n = 5), flap dehiscence (n = 3), and temporal visual field obstruction (n = 8); all were mild and patients either desired no intervention or had subsequent minor surgical management. Conclusions: The lateral tarsoconjunctival onlay flap was effective in this large series of complex lower eyelid retraction.