Will A LeFort I Osteotomy Improve My Scleral Show/Infraorbital Rim Support?

Q: Dr. Eppley, I am undergoing double jaw surgery for my recessed maxilla and mandible. I have a lack of undereye support that has caused sclera show and ptosis in both of my eyelids, resulting in a very tired look at rest. I wanted to go for lower eyelid retraction surgery (possibly with a canthoplasty), but I was under the impression that without adequate support, these surgeries have a high chance of failure. 

I mentioned infra-orbital implants to my surgeon (he does indeed do them), but he said that he wouldn’t indicate them in my case because he didn’t feel I needed them, and that he hopes the sclera show will be less after the surgery anyway. I’m hesitant about this, as the sclera improvements I see from only a normal LeFort 1 aren’t really what I was looking for (neutral/positive canthal tilt, no droopiness of the lower eyelid) . He did mention that he was going to use a High LeFort 1 cut instead to help fill out my cheek and midface more. My question is whether a High Lefort 1 would be enough to help provide support to my lower eyelid such that canthoplasty/lower eyelid retraction would be acceptable. I’ve struggled to find answers to this question online, and while my surgeon is very experienced, he prefers to go for the results that the average person won’t mind (lower eyelid surgery is probably not a thing the average person thinks about). 

Thanks for reading!

A:A Lefort I osteotomy, regardless of the level, can not provide any improved infraorbital rim skeletal augmentation/support. To even think this is remotely possible fails to have an understanding of the basic anatomy of the periorbital region.

Dr. Barry Eppley

Indianapolis, Indiana