How Do I Fix My Drooping Lower Eyelids After Double Jaw Surgery?

Q: Dr. Eppley, I had double jaw surgery around 6 months ago and had impaction because of downward growth. I am now trying to improve my eyes that have droopy eyelids and a fairly negative tilt. While most surgeons seem to say a canthopexy would fix this, could there be a more skeletal problem related to a negative tilt eye shape? I am afraid to be dissapointed by canthopexy results. Are canthal tilt related issues related to something that is skin and muscle or more skull related? I attached pictures of my current eye shape from both the front and the side. It does not appear to have been affected by my jaw surgery at all. Is making an eye shape change even possible? Would getting something such as infra orbital implants or a fat graft be enough to make a shape change, or would it need to be a more complex procedure?

A: By definition when you do double jaw surgery, if there is any significant advancement, you leave the orbital area behind. The maxillary osteotomy cut is well below the infraorbital rims and cheekbones. Thus some patients will develop an orbital or orbital-malar deficiency afterwards particularely those patients that has some mild deficiency beforehand (which I suspect was you).

While I don’t know what yoru orbital area looked like beforehand you have a negative orbital vector now. Givn that the shape  of the lower eyelids follows the shape of the bone underneath it the lower lids swoop done out laterally with a low outer corner posiiton amd increased scleral show.

This is a facial condition that i see all the time and the correct strategy miust be based on structural infraorbital-malar augmentation and lower eyelid elevation. What will absolutely not work are lateral canthopexies alone or fat grafting. While a lateral canthiplasty is needed as part of the structural augmentation it will fail when trying to do so without structural augmentation done underneath to support the vertical eyelid lengthening.  When a skeletal deficiency exists fat graftng is always a poor treatnent choice patticularly in the orbital area where teh volume persistenjce is close to zero and soft tissue addition (even iof it survived) can not support lower eyelid repositiioning.

Dr. Barry Eppley

Plastic Surgeon