Scleral show

[PloskoPlus]

Recently I realised (thanks to kizarq's post) that I have scleral show due to an underdeveloped midface, upper face.  It makes me look tired, dopey and sad, when I'm not.  In fact being alert makes it worse (opening eyes wider).  It's a bit more in one eye than the other, which accentuates the facial assymetry.  I used to  think that my eyes suck because they are small, but I just realised that they look better when I squint.  (I used to think that my wide face was a liability before finding this forum too.  Now I thank my luck stars that it's this wide given how long it is.)

I'll be having a Le Fort I later this year.  The surgeon did talk how it would improve under eye support (another surgeon said the same), but it simply did not register in my head at all at the time.  I did not see this in the mirror, still don't.  Photos jar me back to reality, however.

The question is, how likely is it to be resolved completely?  The surgeon did say "I'll cut higher to fill you out more", but I'm not sure what exactly he meant.
I found this 6-month post-op study:
http://www.sciencedirect.com/science/article/pii/S0278239113012147
But there should still be residual swelling after 6 months which lifts the area somewhat.

Is orbital augmentation a must?  Yaremchuk says here that you can still have upper midface deficiency after Le Fort I.
http://www.dryaremchuk.com/english/orthognathic2.php

Eppley did a pretty impressive job fixing the eyes here:
http://www.exploreplasticsurgery.com/wp-content/uploads/2013/05/Orbital-Asymmetry-Correction-result-Dr-Barry-Eppley.jpg

[Optimistic]

I vaguely remember a thread here last year where it was said that the high lefort 1 often produces the sunken-in eye effect and chimpy profiles. Maybe the normal lefort 1 with orbital augmentation is better?

This can help with scleral show

http://dryaremchuk.com/english/infraorbital-rim-implants.php

[PloskoPlus]

Orbital rim augmentation and midfacial custom implants are a good way of adressing this.

I'd consider speaking about this with your surgeon and opting in for high LeFort I, then wait for it and look if it solves itself. If it's still there, some touch-up implant surgery (Mommaerts, Yaremchuk) may be necessary.

This is sort of my plan.  But jeez, all this stuff takes forever!  I'm guessing that I'm 6 months away from jaw surgery.  It's usually advised not to do anything for 12 months after to make sure all the swelling has gone down.  One the one hand, doing one thing at a time means you may avoid doing unnecessary things and have better control.  On the other hand, maybe a hollistic all-in-one approach by one great surgeon (Mommaerts!) is better .  I really don't know.  For example, my max fac wants to fix my nose at the same time as the jaw surgery (shave down the bump, straighten it, but leave the cartilage alone), and I'm really tempted.  But the Le Fort 1 will tip inevitably tip my nose up and the bump will not be so noticeable.  I'd really hate to end up with one of those scooped out noses if he messes up the bump.

[Gregor Samsa]

I don't think you can have it done all in one surgery. I specifically requested that Mommaerts did orbital rim augmentation on me using HA but he thought a fat transfer was better and he said it was better to do that after the surgery once the swelling has gone down.

[Tiny]

It's it's really bad after surgery then you can look at getting a canthoplasty

[PloskoPlus]

I don't think you can have it done all in one surgery. I specifically requested that Mommaerts did orbital rim augmentation on me using HA but he thought a fat transfer was better and he said it was better to do that after the surgery once the swelling has gone down.

Don't Arnett & Gunson do extensive HA augmentation during the jaw surgery?

[PloskoPlus]

It's it's really bad after surgery then you can look at getting a canthoplasty

The scleral show question is asked quite often on realself (I wonder how many have retrognathia).  Canthoplasty, canthoplexy is the standard answer by most surgeons.
This doctor is the main dissenting voice.
http://www.realself.com/find/California/Los-Angeles/Facial-Plastic-Surgeon/Kenneth-Steinsapir
According to him, it's a skeletal problem first and foremost and should be addressed as such (implant in his case).  Eyelid surgery will make things worse by pulling the lid across the eyeball and make it pop more rather than less.

[MrRochester]

Here is the full text for those interested:

http://www.joms.org/article/S0278-2391(13)01214-7/fulltext

I am getting canthopexy and an enduragen implant myself since I am not getting any surgery on my maxilla and have slight inferior scleral show.

[dovidiostore]

This is a tough one.

Some say, they had a noticeable change in their eye area after orthognathic surgery. I have spoken to someone who had upper jaw surgery with a high LeFort I and girls started to compliment him on his eyes, something never happened before.

Also, see this:


You're right on the spot that midface defiency / hypoplasia often causes scleral show (and negative vector orbit, etc). I have it too. I was told I have an above average eye area in many photos, but that's only because I'm camouflaging my scleral show. It looks horrible and is a significant detractor to one's appearance.

Orbital rim augmentation and midfacial custom implants are a good way of adressing this.

I'd consider speaking about this with your surgeon and opting in for high LeFort I, then wait for it and look if it solves itself. If it's still there, some touch-up implant surgery (Mommaerts, Yaremchuk) may be necessary.

hey whats up bro that was me lmao

[Optimistic]

Would a Zygomatic Sandwich Osteotomy (ZSO) help at all with scleral show provided it involved raising the malars to a higher position?

[PloskoPlus]

Here is the full text for those interested:

http://www.joms.org/article/S0278-2391(13)01214-7/fulltext

I am getting canthopexy and an enduragen implant myself since I am not getting any surgery on my maxilla and have slight inferior scleral show.

Thanks! Sounds quite promising. Who will be doing your implant?

[PloskoPlus]

This is a tough one.

Some say, they had a noticeable change in their eye area after orthognathic surgery. I have spoken to someone who had upper jaw surgery with a high LeFort I and girls started to compliment him on his eyes, something never happened before.

Also, see this:

I can definitely see a marked improvement in the eye area of this woman, but man these before and afters can be hard to judge.  The second photo looks like it was taken with a different lens.  Her nose is practically half the size.