Do You Perform Subcranial Modified Orbital Box Osteotomies?

Q: Dr. Eppley, do you perform subcranial modified orbital box osteotomies?

A: You are referring to a lower 180 degree orbital box osteotomy done through a combined lower eyelid and intraoral incisional approaches, an operation of which I am familiar and have done. It is certainly far less invasive than the transcranial 360 degree orbital box osteotomies which allows it to fall into an aesthetic operation for adults. It is, however, more limited in what it can accomplish and thus its primary indication is when 10mm or less of orbital widening (interpupillary distance increase) is needed. There are two variations of this type of limited orbital box osteotomy depending upon whether some cheek widening effect is also needed.