Earl - there are a number of things that I believe to be important in this area of facial augmentation and I was wondering whether you could raise these issues with Dr. Eppley.
The first is about extending the implant over to the top portion of the lateral orbital rim. Without this aspect, the eyes will still appear bulging because they will not be skeletally encased.
The second is about the vertical placement of the implant. A common phenotype is the high set supraorbital ridge, the most anterior-inferior point of which is set too far away from the upper eyeball. This contributes to excessive upper eyelid exposure and an 'open' supraorbital area. It would be useful to know whether a custom made implant could be placed in such a way that it extends over the inferior edge of the superior orbital rim to sit lower.
The last is the sagittal 'set' of the upper eyelids. This is where the eyelid crease is set too far back sagitally as against the eyeball which contributes to an unaesthetic upper eyelid area. Now this aspect is my own theorising, so it would be interesting to see whether it could be remedied by a supraorbital implant and whether making the upper eyelids more 'forward set' would make a difference.
