What Is The Best Method To Fix My Scleral Show?

Q: Dr. Eppley, Thank you for your detailed answers to my questions regarding sliding genioplasty; I am now much clearer on the process. 

I am also considering two other procedures: something to solve my excessive scleral show and also a lip lift. Similarly to with the chin surgery, I had a couple of preliminary questions prior to scheduling my consultation with you (just so that I am informed on the procedures so I can discuss them with you and make the most of the consultation). 

Regarding the lip lift: It would only be a very slight change I wanted — about 3mm to shorten my philtrum a bit to put my upper and lower lip in better proportion (philtrum to upper lip is currently about 1.8cm). 

Firstly, is there much risk of my nose nostrils dropping down? I have heard this deformity can occur. 

Secondly, is there a risk that my lips would remain permanently parted at rest (showing my teeth)? 

As far as I can tell, the aforementioned issues most often occur when a large amount of tissue is excised from the philtrum. I have again attached my beardless side profile so you can see my philtrum. 

Regarding the scleral show: I understand this to be a complex issue to solve, potentially involving both orbital rim implants (I have attached a couple of images (front and side) — I’m unsure whether I have negative orbital vector) and what I assume is either a canthopexy or canthoplasty plasty. 

I have read your article specifically on canthopexy, and the results you displayed on the lady in the picture did indeed seem to have reduced scleral show — but you and most other reputable surgeons seem to say neither canthopexy or canthoplasty is enough to rectify the problem. What is the true solution to scleral show? Can canthopexy or orbital rim implants ever be enough on their own? 

A: In answer to your questions:

1) A subnasal lip lift of 3mms will cause neither upper lip incompetence or nostril deformations.

2) You do have a marginal negative orbital vector which would also explain why your scleral show is very minimal by comparison to many other scleral show males. If the modest infrarorbital rim deficiency or if you have no desire for a higher cheekbone look, then a lateral canthoplasty with lower eyelid space grafts should suffice.

Dr. Barry Eppley

Indianapois, Indiana