The authors report a retrospective case series of patients, to evaluate the effectiveness of Lateral Tarsal Strip (LTS) and Bick’s procedure (lateral wedge resection) for all types of involutional lower eyelid malposition, at two centres between January 2012 and 2015. The number of patients was 504 and included 286 males and 218 females. The mean age was 76.2 years (median 78). The mean follow-up was 13.07 months (median 7, range 0.5–58 months). A total of 641 procedures (557 LTS and 84 Bick’s) were performed. Out of these 137 were bilateral. The indications for surgery included ectropion (43.2%), entropion (39.9%), eyelid laxity (12.3%), floppy eyelid syndrome (2.7%), and others (1.9%). At the last follow-up, the LTS group achieved 89.1% anatomical success (total + partial correction) compared to 100% in Bick’s group (P < 0.001). Functional improvement was 82% and 95% in LTS and Bick’s groups, respectively (P=0.002). Consultants and trainee doctors achieved comparable outcomes within each group. Complications were relatively minor with no major long-term sequelae, nor any statistically significant difference between the two groups in terms of frequency of adverse events (16.9% vs. 14.2%, P=0.929). Among common complications, granuloma formation and wound dehiscence were mainly encountered mainly in the LTS group, while the infection rate was similar in both groups. LTS from the lateral canthus to the lateral orbital rim has the potential to damage the integrity of the lateral canthal tendon (LCT). Bick’s avoids the LCT altogether. Second, in the LTS, tarsal plate (made up of Meibomian glands) is deliberately buried. This is not the case in Bick’s procedure, which may explain why granuloma formation at the lateral canthus is not observed with this technique. The reoperation rate was 9% in the LTS group during the study period, compared to none in the Bick’s group (P=0.001). The reoperation rate was 9% in the LTS group during the study period, compared to none in the Bick’s group (P=0.001). Median interval to failure and or reoperation was seven months. Bick’s procedure achieved statistically significant better anatomical and functional outcomes compared to LTS, although the samples were unequal and not randomised. Limitations: Retrospective design with potential bias in patient selection and lack of masked evaluation of the outcomes, unequal sample sizes, and differences in the grades of surgeons. Additionally, there were some differences in terms of the proportion of different types of eyelid malposition. A significant group of patients were discharged after a short follow-up. A prospective randomised controlled trial comparing the outcomes of the two procedures may be able to clarify issues further.