Lower Eyelid Retraction Getting Worse Each Year. What To Do? (photo)

Midface lifts and canthoplasty / canthopexy could help but it could make it worse. You would be taking a significant risk with these procedures. It really depends on how important it is for you. But you could look worse than you are right now. Fillers and fat injections could help a bit and I would start with these. Midface lift and canthal procedures would be one of the last resorts.

Your posted photo shows outer eyelid corners lower than inner (even more so on the left) and lower eyelid margins slope downward with a bit of a notching on the left lower eyelid. It is not possible to make any recommendation merely on the basis of this photo. We need to know how supple the eyelids are. If they are tight and you try a canthopexy or canthoplasty alone you will make the situation much worse. Suppleness is not something you can assess from a photo. It is something you note in a face to face examination. I suspect you will need repositioning of the outer corners and a graft (possibly a composite graft) to increase support for the eyelids. I cannot see how fat grafting alone or injection of a dermal filler would help you at all. I think that would be a waste of time and money.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

A midface lift without the underlying support will not be long lasting result in my opinion.

You certainly have low lateral canthal position [canthal dystopia]. A posterior eyelid graft with Enduragen, or Hard palate with canthopexy/plasty would be a good start for you if you want to be more conservative.