What Procedures Do I Need To Achieve A Successful Vertical Facial Shortening Effect?

Q: Dr. Eppley, I would like to have a revision canthoplasty with an orbital rim of cheek implant for projection and support. I had a canthopexy a year ago, done by an oculoplastic surgeon which was a failure. Within less than a month my eyes were back to their natural state. This surgeon had also suggested fillers in the temples, cheeks and undereyes to balance out my long face shape and give it volume from the side. What do you suggest for my eyes? I am also open to suggestions for the face. 

A: Thank you for your inquiry and sending your picture and a description of your concerns. It is no surprise that the use of a canthopexy in the negative canthal tilt/undereye hollow patient failed to hold its position other than for a very short period of time. Besides the fact that a canthoplasty is needed for more secure canthal positioning, failing to add support for the lower eyelid via either spacer grafts or infraorbital rim augmentation even dooms a good lateral canthoplasty. In the end something must hold the eyelid up or even the most secure form of tethering will likely fail.

As for the longer face the basic approach is to look for vertical shortening and widening effects that would be aesthetically beneficial. Vertical facial shortening could be done by either frontal hairline advancement (upper third reduction) or vertical chin reduction (lower third reduction) or both. This address the long face directly and are the most effective. Widening has a complementary effect of which temporal and/or cheek augmentation are the two choices. Thus you have five types of facial reshaping procedures to consider. Which ones work the best requires computer imaging of them separately or in combinations to see which ones make the biggest differences. You may already have a feel for what you think is most important and if you can tell what you think that is I will be happy to some imaging for you.

Dr. Barry Eppley

Indianapolis, Indiana