Actual box osteotomy patient, as well as every other extreme surgery

[bottleofwater]

Hello, I am an OG from puahate, and certainly the most surgically experienced person in PSL history. I will make threads in the future about other topics, but here I want to answer questions about the OBO I had.

I went from 65.5 mm IPD (on a 154 mm bizygo face) to a 72 mm IPD. I've attached a picture of my surgical plan. I also had my left eye raised relative to the right for symmetry, and my "boxes" rotated so that my cheekbones would be higher on a framework level, not just augmenting with implants, though I did have permanent filler in the area already, as well as infraorbital implants from Taban years ago (he sucks, actually worse than Douglas/Massry and Eppley, had cantho or lower lid retraction surgeries by all of them).

I was hoping the rotation would lead to more PCT but ultimately the canthal ligaments and whatnot resettle at their previous elevation. My canthos were not performed that great, but I did tons of research and got a follow-up drill-hole cantho with lower lid fat grafting by Eppley, and he gave me better results than any oculoplastic I tried previously (including 2 attempts by Taban).

My doc was Derek Steinbacher. I messaged a bunch of craniofacial/plastic combined specialty surgeons as found by google searching ("craniofacial plastic") and he was the one to respond.

Recovery was gnarly, not too painful, but I was functionally swollen blind the first few days. Months to regain eyebrow movement and general facial sensitivity. The right side of my upper lip extending upwards to encompass the buccal region is still experiencing numbness/parasthesia, but it's whatever. Overall I'm pretty happy with how it went. Attached a pic of my pre-surgical plan.

I'm sure this will attract a lot of interest, but I am quite busy so please don't dm me much, I'll answer various q's here. I'm not gonna show before/afters because I want to protect my identity.

Edit: May as well just use this thread to answer any questions about any surgeries at this point. I might make threads more specific to certain things (eye shape, LL, facial de-bloating, etc.) in the future.

Does it also fix vertical optical dystopia?

 

[Amor Fati!]

OP, I don't say this to be unkind - but it's important to point out that this type of result, particularly involving orbital box osteotomy for aesthetic reasons, appears to fall outside the realm of established facial harmony.

A 72mm IPD is unusually wide, and when paired with a wide mid-face region, it can create a stretched, doll-like appearance that disrupts natural balance. If you're happy with the outcome, then that's great - but I definitely think others should remain cautious. It is very easy to "fix" one issue by creating an entirely new imbalance. Not every 'after' is better simply because it is more dramatic.

Most surgeons would consider OBO as a last resort for congenital deformities, not a go-to for cosmetic refinement. No one should take this surgery lightly.