How Does An Inferior Orbital Box Osteotomy Work?

Q: Dr. Eppley, I would really like to ask you about surgical techniques for increasing eye distance. As I have read in your answers to similar questions in the past, increasing distance between eyes horizontally is quite challenging, and I understand that the most effective procedure is the orbital box osteotomy. This is however too extreme for me and I believe the change I’m looking for definitely does not justify the procedure. However, I have read a few more recent posts of yours where you describe less comprehensive procedures, such as periorbtial implants and a modified subcranial 180 degree orbital osteotomy. In less medical terms, what do these procedures entail and which, if any, would achieve a 6-8mm increase in interpupillary distance (which is what I would be looking for)? How difficult and predictable are the surgeries? How big are the risks?

A: Alternatives to a 360 degree orbital box osteotomy is considered in patients who have aesthetic hypotelorism (aka decreased interpupillary distance) in which the need for the increase in interpupillary distance is less thana combined 10mms or 5mms or less on each side) The inferior orbital box osteotomy exists for that purpose which is done through a combined lower eyelid and intraoral approach. The ‘problem’ with this approach is its unpredictability. Will it achieve a 6 to 8mm increase in IPD or will it end up as 4 to 5mms? Impossible to know for sure beforehand.