Can A 180 Degree Inferior Orbital Box Osteotomy Create A Small Intercanthal Distance Increase?

Q: Dr. Eppley, I wanted to ask about the feasibility of achieving a small, conservative increase in intercanthal distance (approximately 2–3 mm total or 1-1.5mm per side) through a combination of limited bony and soft-tissue approaches.

Specifically, I was wondering whether a 180° orbital box osteotomy combined with soft-tissue adjustments such as medial canthoplasty / medial canthal tendon repositioning, could potentially create a modest increase in ICD while preserving the natural length and shape of the medial canthus (i.e., without visible shortening or distortion of the inner eye corner).

A:An inferior orbital box osteotomy works best for modest increases in the intercanthal distances. Technically it is not really 180° as the inner bone cuts cannot cross the bony location of the lacrimal sac.

The required soft tissue procedure in the corner of the eye to increase the distance between the two sides is not a medial canthoplasty.. This is done by V-Y lengthening procedure of the external lacrimal lake area which moves/closes down the inner eye corner out 2 to 4 mm on each side.

Dr. Barry Eppley

World-Renowned Plastic Surgeon