The aim of this study is to analyze the development of lower eyelid malposition following reconstruction of orbital fractures, in relation to the incisions used for access. A total of 198 surgical orbital floor reconstructions were performed in 175 patients between 2001 and 2011. Preoperative and postoperative presence of lower eyelid malposition of patients was reported. The types of incision used for access were as follows: approach via laceration (4.5%), via preexisting scar (16.2%), infraorbital (40.9%), subciliar (23.7%), transconjunctival (13.1%), and transconjunctival with lateral canthotomy (1.5%). The incidence of ectropion development following surgery was 3.0% and the incidence of entropion development following surgery was 1.0%. The highest rate of ectropion (11.1%) was seen using an approach via a laceration, followed by approach via a scar (6.3%). Our conclusion is that the transconjunctival incision without a lateral canthotomy has a low complication rate, provides adequate exposure, and leaves no visible scar.