How Can My Negative Orbital Vector and Sagging Lower Eyelids Be Fixed?

Q: Dr. Eppley, I’m looking to infraorbital implants or infraobital-malar implants. My infraobital bone is deficient and it creates a negative orbital vector, dark under eyes, unsupported, round eyes. I want to create a more sharp appearance to the eye and more under eye support. I’d be very to keen to do a virtual consultation with you as soon as possible if you believe you can help me.

A:Thank you for sending all of your pictures and detailing your facial concerns and objectives. In reviewing your pictures you are correct in that you have a significant negative orbital vector and all of the associated periorbital orbital findings that come with it. Certainly the fundamental treatment is infraorbital – malar custom implants (see attached example IOM design for this problem) to correct the skeletal deficiency and Improve the under eye support. But this alone will not be fully adequate in the correction of the sagging lower lids with excessive scleral show. In severe cases like yours you cannot count on the implant alone to drive up the lower eyelids to any significant degree. This also requires lower lid spacer grass and a lateral double hole canthoplasty which is performed at the same time as the implants. It takes an all-out effort to maximize whatever result as possible from these techniques.