How Can I Get Rid Of The Bunched Up Tissue under My Eyes After A LeFort I Impaction Surgery?

Q: Dr. Eppley, I am a middle age male whom found a post you wrote, which is one of the few bits of information I have found online regarding a problem I have and I would be very grateful for some advice as I’m not sure what to do. This is the post I found: 

I had double jaw surgery almost twenty years ago. My lower jaw was moved forward to correct a large overjet and my upper jaw was impacted to correct a gummy smile. I was warned that I could develop extra lines under the eyes that I didn’t have before. Unfortunately this happened to a much greater extent than I expected. It is very apparent when i smile or make any facial gestures. Even when I talk I get the lines to a lesser extent. It has effected my confidence and i have avoided photos a lot. I also haven’t seen anyone else with a similar problem which makes it more frustrating. 

I have found it very difficult to find much information on this. I’ve tried Botox but it didn’t do much. I tried injectable fillers last year but it didn’t do much. I had a consultation with a dermatologist who told me that I have lost volume and filler would solve it. I also saw an eye surgeon who didn’t think filler would help. He said he couldn’t remove some of the bunched skin when i smile as the skin is taut at rest. 

It feels to me that there is too much force pushing the skin under the eyes when i smile and it is causing it to bunch and crumple. It feels to me that I have too much tissue under the cheek bone area that is pushing the skin and I have hardly anything under the eye area to resist the push! Not sure I had much under the eyes to begin with as I had a long thin face prior to surgery. But I feel like I’m just guessing. 

Any help would be much appreciated! 

A: Thank you for your inquiry and sending your pictures. Unfortunately more pictures than just a frontal smiling one are needed for a more comprehensive assessment. (non-smiling and smiling front and side views) But based on your surgical history and description of symptoms I would initially speculate that what you have is ‘too much tissue’ for the vertical midface bone height. Thus it bunches up a lot because there is a mismatch between the amount of soft tissue (which hasn’t been changed) and the vertical midface bone height (LeFort I impaction) which has. This would suggest that this isn’t a volume issue (which is why filler will not work) but an excess tissue one. It may be appropriate for a lower blepharoplasty-midface lift…but I would need to see what your undereye-midface looks like when you are not smiling.

Dr. Barry Eppley

Indianapolis, Indiana