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

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.