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

WIth due respect to Dr. Friedenthal, canthopex will actually worsen your inferior scleral show.  Canthopexy effectively shortens the lower eyelid.  This means that the lower eyelid will find the shortest path around the globe.  This shortest path is currently a curved path just under the colored portion of the eye.   Shortenting the lower eyelid with a canthopexy will force the lower eyelid to follow an even shorter curve around the eye which will paradoxically cause  the lower eyelid to sit even lower on the eye after surgery.  For similar reasons, midface surgeries will also be problematic for you.  Under eye fillers can be a helpful option.  I encourage you to study these options on my website.  Don't rush into surgery for this issue as fixing bad midface surgery is much more expensive that the original midface surgery.  I am concerned that you have done enough research to get yourself into trouble.

The photos show an anti-mongoloid slant of the eyes and relative midfacial hypoplasia.  These findings in facial terms are sometimes referred to as "polar bear" syndrome.  I would recommend extreme caution in pursuing surgical options, because a large portion of the problem is a lack of midfacial volume and structure as opposed to eyelid laxity.  I would suggest incremental use of Sculptra (at least 3 sessions) or fat grafting to address this issue.  Surgery may compound your aesthetic concerns with functional problems.

   Fat grafting or fillers to the area may help, but an exam will be necessary to assess eyelid laxity and level of support.  Kenneth Hughes, MD Los Angeles, CA

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.

Many surgeries COULD be done but there all come with a potential "price" - and I do not mean money. Midface lifts in conjunction with canthopexy or canthoplasty may be an option. Even in expert hands this can easily result in asymmetries, worsening of your condition or just a different but not better look.

If you would be my relative I would start with conservative fat grafting only to improve upon the described volume issues and take it from there. Less is often more - certainly in your situation.