Q: Dr. Eppley, I am a 28 yo female who has a negative orbital vector bilaterally. I don’t have a history of zygomatic fractures, but I suspect the lower eye bone and cheek complex did not grow forward enough. Do you perform zygomatic osteotomies electively? I have seen your work in patients with old orbital fractures which really brings forward the cheekbones. Can such a zygomatic osteotomy technique be done for someone with a negative orbital vector.
A: The treatment of a negative orbital vector would not be done using zygomatic osteotomies. They will not being the cheek and orbital rims forward. Zygomatic osteotomies increase cheek width but not anterior projection. Only onlay bone augmentation will do so and that is best done by custom made implants. The creation of infraorbital rim-malar implants placed through a lower eyelid incision is the best way that I know to effectively treat a negative orbital vector. It is commonly believed that these bones can be moved forward, like the jaw bones below them, but such bone osteotomies are unduly complicated and associated with bony irregularities. It is far easier and more effective to create custom infraorbital-malar implants from the patient’s 3D CT scan to treat a negative orbital vector.