What is the current consensus around Tripod Osteotomy? Who can get it?

[SubhumanityForce]

Does the tripod osteotomy affect the pfl? Where is the lateral canthus connected to? If let's say you will be able to get this osteotomy, will your pfl increase anyways? My pfl is huge (34mm without measuring the upper eyelid while closed, which makes it look even larger) , while my inter canthal is 30 or 31mm. My IPD is around 68mm (Opry Tier) but my CT scan shows my bizygo to be 13.6 (minimum total soft tissue for skinny guys (im fat) is 6mm so lets say i have a 140mm bizygo (Should go for 147 ideally).
The reason im asking for tripod to make the curve from mid eye towards lateral walls of orbital bones look smoother , something closer to squared orbits (can go for supras later).
But my pfl is already huge so, is there a way to get a tripod osteotomy but keep the pfl the same? (if i push my lower eyelid up btw, my eyes look good and hunterish (even tho i dont have good supra projection at all, just not gook tier)
Also, another reason is for my IPD, its better to have thicker lateral orbital walls but sometimes my lateral canthus feels like its ON TOP of the lateral walls (meaning that the inner side of the lateral orbital walls is behind and more towards the centre of the face, than my lateral canthus )
Also, can the mid to lateral part of the supraorbital be shaved to give a more squared shape? (And also help the eyelid move up to avoid this tired look when relaxed.





@RealSurgerymax @thecel @misc001

 

[HerpDerpson]

People can't tell without pics and nobody offers this anyway.

 

[SubhumanityForce]

People can't tell without pics and nobody offers this anyway.

In orbital decompression, epley shaves parts of the lateral walls next to the eyeball. Why wouldnt he shave a bit of the outer supra

 

[SubhumanityForce]

Any ideas?

@RealSurgerymax @Titbot @CosmicMaxxer

 

[mvp2v1]

In orbital decompression, epley shaves parts of the lateral walls next to the eyeball. Why wouldnt he shave a bit of the outer supra

honestly, you dont even need an osteotomy IMO, you could just shave that top section, and then use implants to make up for the lost bone up top and on the sides, as well as on the bottom. You could create the square shape without any osteotomy. @RealSurgerymax

 

[RealSurgerymax]

Does the tripod osteotomy affect the pfl? Where is the lateral canthus connected to? If let's say you will be able to get this osteotomy, will your pfl increase anyways? My pfl is huge (34mm without measuring the upper eyelid while closed, which makes it look even larger) , while my inter canthal is 30 or 31mm. My IPD is around 68mm (Opry Tier) but my CT scan shows my bizygo to be 13.6 (minimum total soft tissue for skinny guys (im fat) is 6mm so lets say i have a 140mm bizygo (Should go for 147 ideally).
The reason im asking for tripod to make the curve from mid eye towards lateral walls of orbital bones look smoother , something closer to squared orbits (can go for supras later).
But my pfl is already huge so, is there a way to get a tripod osteotomy but keep the pfl the same? (if i push my lower eyelid up btw, my eyes look good and hunterish (even tho i dont have good supra projection at all, just not gook tier)
Also, another reason is for my IPD, its better to have thicker lateral orbital walls but sometimes my lateral canthus feels like its ON TOP of the lateral walls (meaning that the inner side of the lateral orbital walls is behind and more towards the centre of the face, than my lateral canthus )
Also, can the mid to lateral part of the supraorbital be shaved to give a more squared shape? (And also help the eyelid move up to avoid this tired look when relaxed.





@RealSurgerymax @thecel @misc001

honestly, you dont even need an osteotomy IMO, you could just shave that top section, and then use implants to make up for the lost bone up top and on the sides, as well as on the bottom. You could create the square shape without any osteotomy. @RealSurgerymax

Correct. This is osteoplasty with a burr. Easy

Upper bleph will probably be necessary for redunadant skin.

The skeletal reduction can’t be as much as pictured because your lacrimal sac will herniate.

 

[iseeblue9]

Correct. This is osteoplasty with a burr. Easy

Upper bleph will probably be necessary for redunadant skin.

The skeletal reduction can’t be as much as pictured because your lacrimal sac will herniate

What about the long terms side effects of obo @RealSurgerymax are u planning to be clear about the downsides of obo

 

[SubhumanityForce]

Correct. This is osteoplasty with a burr. Easy

Upper bleph will probably be necessary for redunadant skin.

The skeletal reduction can’t be as much as pictured because your lacrimal sac will herniate.

@RealSurgerymax then what about instead of that much skeletal reduction theres a way to either rotate the sockets with a fixed pivot point near the nose, or just cut the outer half of the orbits along with a cut on the zygo arch and lift that part straight up in a linear movement?

 

[Deleted member 85787]

Bad icd with a good pfl i have the same, but in my case it is even more serious because i have a low ipd i will do obo

 

[SubhumanityForce]

Bad icd with a good pfl i have the same, but in my case it is even more serious because i have a low ipd i will do obo

Your case is easier because you have bad icd and bad ipd, obo will move bones with your eyeball together so you increase them both

My icd is 30mm (34 ideal for my skull) but my ipd is already 67. If i do what you will do I will end up with a 71mm ipd. So that means i will need OD or shaving of the medial orbital wall after that. However since my pfl is big, doing that will expose more of my lateral (outer) sclera compared to the medial, which will make me look like a weird elf Taylor Joy

@RealSurgerymax

 

[SubhumanityForce]

Correct. This is osteoplasty with a burr. Easy

Upper bleph will probably be necessary for redunadant skin.

The skeletal reduction can’t be as much as pictured because your lacrimal sac will herniate.

Wait. Are you talking about my picture? The lacrimal sac is on the medial wall of the orbital. I sketched a reduction of the downward supraorbital bone at the outer part of the eye.

@RealSurgerymax

 

[RealSurgerymax]

Wait. Are you talking about my picture? The lacrimal sac is on the medial wall of the orbital. I sketched a reduction of the downward supraorbital bone at the outer part of the eye.

@RealSurgerymax

Lacrimal gland*