Will Subtotal Inferior Box Osteotomies Increase My IPD by 2 to 3mms?

Q: Dr. Eppley, I have been discussing modified aesthetic OBO and I only believe I need about 3mm of IPD increase which is well within the capabilities of your method. I had narrow eyes before skeletal expansion (MARPE) and although it did actually increase my IPD slightly, it widened my cheekbones proportionately. I think a few mm of IPD widening would not only fix my eye spacing itself, but also make my nose look more proportionate, and my face less long. Combined with some implants around the eyes to support them better, I think it would be well worth going through with the procedure, so I hope you don’t consider my eye spacing to be too borderline to be worth such a surgery. After all this I will get double jaw surgery and be done with all my surgeries.

I hope to hear back from you about what can be done about my case.

A: I would certainly agree that for 2 to 3mms of IPD increase any OBO procedure that involved a frontal craniotomy or a bicoronal incision would be a good example of a ‘solution thaf is bigger than the problem.’ Inferior subtotal orbital rim movement done through a combined lower eyelid and intraoral approaches works fine for a few mms of IPD expansion. (not as effective for IPD decrease) How that would/should work with any periorbital implants/augmentation is yet unclear. The first place to start is getting a 3D CT scan for orbital anatomy and treatment planning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon