Should I Have Periorbital Augmentation Before or After Orthognathic Surgery?

Q: Dr. Eppley, Would it be unwise to undergo total periorbital augmentation, potentially including the zygomatic arch, PRIOR to orthognathic surgery in both jaws? I suppose this is an issue mainly for the infra orbital rim part of the implant design process. The aesthetic concern is, for the most part,vertical deficiency that results in round, saggy – retracted lower eyelids as shown in attached photos. However, since some degree of horizontal augmentation may be necessary, wouldn’t that impact either the implant design process with you or the surgical planning with the maxillofacial surgeon? 

Thank you in advance.

A: The level of a LeFort I osteotomy is below the infraorbital rim (technically below even the infraorital nerve) As a result, periorbital augmentation and orthognathic surgery are done at two different facial bone levels. Thus their order of execution is more of an aesthetic choice. While it may seem that one area affects the other from a treatment planning standpoint, it does not.

Dr. Barry Eppley

Indianapolis, Indiana