What is the best option for a drastic lift on the lateral canthus and a pull on lower eye of downturned/droopy eyes? (photos)

You have lateral canthal dystopia and lower eyelid retraction. A canthoplasty alone will likely give you a short term improvement, if anything at all. Your best bet at a long term solution is a lower eyelid retraction repair with an internal graft to elevate the out corner of your eyelid, along with a lateral canthoplasty. Usually, when it comes to eyelid surgery, Oculofacial plastic surgeons (Oculoplastic surgeons) have the most experience. That is not to say you cannot find a great facial plastic surgeon or general plastic surgeon that also gets great results. Research your surgeon to make sure that they have excellent experience in this type of procedure. Beware of posts that state "seek only a consultation with Board Certified Plastic Surgeons". It is a clear indication of a "turf war" between specialties that has nothing to do with patient care. Good luck

The challenge in diagnosing your own issue is that doctor will try to solve that problem for you, right or wrong. You have a mild lateral canthal issue. However the most significant issue you have is bilateral upper eyelid ptosis with compensatory eyebrow elevation. This creates a very long eyelid. The lateral canthus can be supported at the time of ptosis repair. I do not believe based on the pictures that you need and extensive lower eye lid procedure. There is no substitute for personal consultation.

In order to achieve long lasting change in eye shape you are describing, need to raise the lower eyelids and canthus, NOT just canthoplasty. It is called lower eyelid retraction surgery with canthoplasty. There are definite limitations based on individual anatomy. Expertise is critical.

Thank you for your pictures and questions. I would suggest you go for a few consultations with local plastic surgeons who are board certified by the American Board of Plastic Surgery. There may be several opinions on how to address your unique situation. The "pulled" photos that you shared show an unnatural lateral pull with too much lateral scleral show. I think that a full face photo or exam would be very helpful to evaluate your mid-face as well. You might benefit from a combination of mid-facial volume and support coupled with a lateral canthal procedure to change the vector/tilt of the eye. Complicated cases can sometimes require complicated solutions.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

The position of the outside corners of the eyes are too low giving you "negative" eyelid vectors (downward slope from the inside corners to the outside corners).  This appearance is due to the corner of the eye, known as the lateral canthus, attaching too low on the lateral orbit.  Correction requires releasing and elevating the lateral canthal tendon and reinserting at a higher point on the inner aspect of the lateral orbital rim.  Temporal lift, subperiosteal facelift, etc will not achieve your desired benefit.Good luck with your desired surgery!