Should I get eyelid surgery with lateral tarsal strip or a skin graft?

Your images show a downtuning canthus, prominent eyes, a relatively flat cheekbone,  and maybe some mild lower eyelid excess horizontal length.  It is possible that you might have a congenital condition causing this configuration, with abnormal findings on an exam. It's also possible that your exam would be largely normal and that this configuration is simply your genetic heritage. 

The repositioning of tissues you are  demonstrating by pulling the corner of your eye towards the bone with your finger can be accomplished  with surgery, but the specifics of how this would be best accomplished would be  best determined at an in-person consultation with an eyelid specialist.  Options include non surgical fillers, a canthoplasty/lateral tarsal strip with recession of your lower eyelid retractors - possibly with a graft, or even a midface elevation. 
Again, it would be best to meet with a few surgeons to get a good look at your anatomy and options. Good luck!

Thank you for your question.  It does appear that the contour appear lower eyelids is such that you would benefit elevation of the lower lids, especially over the outer portion.  I would not recommend skin grafting for a number of reasons.  While an examination person will be required to make a definitive plan, elevation of the lower lids with a graft inserted inside the lid is the approach that is most likely to give you satisfactory improvement in your eyelid position.

While the skin graft approach is effective in helping to elevate the lower eyelid, it is highly disfiguring.  The skin graft simply never looks right.  For that reason we have develop the use of graft material inserted behind the lower eyelid to minimize evidence that such an extensive reconstruction has been performed.  The big problem that you prior surgeons did not deal with is the shape of the lateral orbital rim.  I approach this work with a hand carved ePTFE orbital rim implant and vertically lift the midface.  Additionally a hard palate graft is used to control the shape of the eyelid.  A lateral canthoplasty is used to close the area but it is not used as a structural element of reconstructing the eyelid.  The canthoplasty simply does not have the strength to do that.

froould not need a skin graftm your photos a canthopexy would change the position of your lateral canthus and bring it up. Unless you have skin loss under your eye from prior surgery you sh

This depends on several factors.  However, from just looking at the pictures, I would likely suggest a spacer and a lid tightening procedure.  The best advice I can give you is see a surgeon who specializes in these types of cases as they can be challenging to achieve excellent results.  Good Luck
Dr Z

Thank you for your question. A canthopexy or tarsal strip alone would likely not fix your issue and may even make it worse. Your eyelid is positioned low. This is not likely due to skin shortage and a skin graft would not help. Your eyes  are prominent and you have shallow malar (cheek) bones. A lateral tightening should only be performed as part of an operation to elevate your cheek and perhaps augment the orbital rim. Please go see an ASOPRS affiliated Oculoplastic surgeon who is qualified to evaluate you in person. An online consult is not sufficient for an adequate evaluation.

The lateral rounding of your eyelid should respond to a lateral tarsal strip and lid shortening to elevate the eyelid up into the position that you desire. Only if you don't have enough skin to redrape into the new elevated lid would a skin graft be required. The amount of elevation possible depends on how prominent your eyeball is in the eye socket (orbit) so a thorough examination is required to determine whether you are a candidate for a lid shortening and canthopexy. John Standefer MD

Thank you for your question. The answer to your question depends partially on the origin of your ectropion. Judging by your pictures you will likely best be served a canthoplasty and potentially a lid shortening procedure such as a tarsal strip. It is most important that you see a surgeon who can do a full evaluation. Best of luck. 

I assume you had a lower blepharoplasty, or an eyelid injury.  I think you should see an opthalmic plastic surgeon, usually an ophthalmologist with specialty fellowship training in plastic surgery of the eyelids. they have the ultimate expertise in complicated eyelid issues, which most general or facial surgeons do not.

I would say that either a canthopexy or tarsal strip procedure is appropriate for you, and unless you had severe scarring along with skin loss a skin graft procedure would not be necessary.Good luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon