Do I Need A Lateral Canthoplasty with Custom Infraorbital-Malar Implants?

Q: Dr. Eppley, I’m 33-year old male and have recessed cheeks in all directions. I have been considering getting custom cheek implants for some time now. I’m interested in something like the following patient of yours: 

I do not have scleral show and my eyes are positively canted but I do have negative orbital vector. Please see attached photo of my eye area. 

My doubts are these: 

— If I have a similar surgery like the patient in the link above; that is, around 7mm elevation of the infraorbital rims with cheek projection of 6mm would my tissues support such volumes given that tissue-wise I’m not that receded? Or would I have to also undergo canthoplasty? I would rather avoid it if possible. 

— With a 7mm elevation of the infraorbital rims wouldn’t this cause problems to my vision? Potentially covering my pupils? Would it make it difficult for me to look down at stuff? Or would I have to move my entire head downwards to look at stuff below my eye level? 

— Would it be possible to augment the infraorbital rim region anteriorly a little more than this patient so that the implant doesn’t scoop inwards as much in this area? I imagine if there’s more volume here this would result in more deep-set eyes which is what I want.

A: Thank you for your inquiry and sending your pictures. In answer to your custm infraorbital-malar implant questions:

I am not sure where you can up with the need for a 7mm height of the infraorbital rim component of the implant. That amount of height increase is only done when one has a congenital rim deficiency, lower eyelid sag, and/or a negative orbital vector….none of which you appear to have. Based on very preliminary information (one picture and your description I see only a minimal need for infraorbital rim height increase…only enough (2mms) to support the desired horizontal rim augmentation. Thus no lateral canthoplasty would be needed either.

Dr. Barry Eppley

Indianapolis, Indiana