Is It Possible To Widen The Bones Around The Side Of The Eye To Give The Broad Eye Look?

Q: Dr. Eppley, I’m a 32 year old man. I want a customized implant to provide forward projection to my infraorbital rims. Uniquely, I want this implant to move the frontal process of the maxilla forward. Here, I am referring to the point at which the infraorbital rim meets the frontal process. This would typically be a portion of the face moved by the Le Fort 2 osteotomy. I want to raise my infraorbital margin too. I want this implant to extend onto the zygomatic arch to provide a small amount of lateral projection there. I want no lateral movement of the zygomatic body, because I dislike cheekbone mass. 

The key objective for me however, is to widen the perceived appearance of my orbital complex. I’ve noticed that this is an under appreciated and core aspect of beauty that most male models possess. I believe that this is possible by widening the brow bone, the lateral orbital rim and the zygomatic arch. 

I have so many questions on the theory of this, but I will limit them to 4 questions for your blog, and for now I will ignore the brow bone aspect. And then maybe send another email for a further round of questions. I hope this is ok with you. 

1) Is it possible to widen the bones that surround the side of the eye, to achieve this ‘broad eye area’ look? I believe that the answer is yes, but I’m unclear how to preserve harmony with the anterior temporal area. My concern is that making the lateral orbital rim project laterally, will create an unnatural ratio between the width of the lateral orbital rim and the width of the anterior temporal zone. 

In your experience, is this easily resolvable by extending a lateral orbital rim implant into the anterior temporal area to widen it to the same degree? And most importantly, does this look completely natural and not too ‘egg’ shaped? 

2) Regarding raising the infraorbital margin – my concern is that if I’m simultaneously raising and pushing forward the infraorbital rim – would this not create an unnatural appearance by making the infraorbital margin sit well above the lower border of the obicularus oculi? Obviously in its natural form, the infraorbital margin and the obicularis oculi have a high degree of correlation in their vertical positions. I am concerned about pushing the rim forward, too high above the natural position of these muscles. Might we do a SOOF lift with lower eyelid retraction surgery to resolve this problem? 

3) I’m also aiming to get a few other eye procedures: cosmetic orbital decompression for bulging eyeballs, a canthoplasty to raise my lateral canthus, surgery to raise my lower eyelid, and eyelid fat grafting to resolve soft tissue hollowness. I’d like your opinion on which order I should do these surgeries in? Would it be sensible to do decompression first, or the midface implant first? I also had the idea that doing the eyelid fat grafting may mitigate my concern in question 2, by obscuring the boundary of the implant edge – does you agree that it makes sense to do the fat grafting first? 

I’m looking forward to your answers, and thanks so much for your time.

A: In answer to your custom midface implant question:

1) You are correct in that you must be vigilant about how much lateral orbital rim augmentation is done to not create the appearance of unaesthetic temporal hollowing.

2)) You can extend the lateral orbital rim augmentation onto the deep temporal fascia of the temporal region…but there are limits in doing so.

3) I have not seen the vertical elevation of the infraorbital rim cause the problems to which you refer. Even up to 8mms of elevation this has not occurred with the caveat in the presence of someone with abnormally low infrraorbital rim levels.

4) It would most appropriate to do orbital decompression and any procedure that may change the position of the eyeball and eyelids first.

Dr. Barry Eppley

Indianapolis, Indiana