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In most people, the relationship between the ocular globes and the cheek tissues is such that on lateral view, the cheek projects beyond the eye. This relationship, due primarily to the development of the facial bones beneath the cheek tissues, has been termed a 'positive vector'.
When the midfacial bones are lees fully developed, the eyes look prominent. On lateral view, the eye projects beyond the cheek. This relationship has been termed a 'negative vector'. Patients with negative vector skeletal morphology have less support for their cheek and lower eyelids. With aging, gravity causes their cheek and lower lid to descend prematurely, compared to patients with more prominent midfacial skeleton. Furthermore, these patients are predisposed to having further lower lid descent with scleral show, round eyes (and 'dry eyes') after conventional lower bleparoplasty.
Dr. Yaremchuk has designed an implant to correct this problem. Implant augmentation of the infraorbital rim (the bone behind the lower eyelid) increases the projection of this area "reversing the negative vector" (this is different than a cheek implant).
By improving the underlying skeletal support with an infraorbital rim implant, lifting the midface soft tissues, and tightening the lateral corner of the eye (lateral cantopexy), the 'round eye' appearance of patient with midface hypoplasia (negative vector) – can be corrected.
Clinical examples of patients who have had these procedures are presented in the patient examples section of this web site.
Illustrations by Kip Carter, MS CMI.
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