If you have marked laxity of the lower lids, and the lateral portion of the lid is low, and/or the tear drainage opening (the punctum) is everted, then tightening the lid may help with the outflow of tears. You also need to check to make sure you have a patent tear system within the nose. When we tighten the lid, this can help to restore the correct anatomy of the lid and the muscle action of the lid can improve to help move the tears into the punctum. It needs to be done by someone who does a lot of eyelid surgery - an oculoplastic surgeon, who can also evaluate the tear system. While this surgery can help, for some patients the improvement can be minimal.