Background and objectives: The orbital region is a significant aesthetic unit contributing to the facial aesthetics. There should be no sclera exposed either above or below the irises in neutral head and relaxed eyelid position in a patient who has normal skeletal pattern. The aim of this study was to evaluate the decrease of sclera exposition and proportional relationships between the orbital region and the face following maxillary advancement and/or impaction in patients with midfacial retrusion.

Methods: Forty-seven consecutive patients (24 male/23 female) who were treated with Le Fort I osteotomy were included. Patients were divided into two groups according to type of the maxillary movement; Group I underwent maxillary advancement ( n = 23) and Group II underwent simultaneous maxillary advancement and impaction ( n = 24). Standardized preoperative and sixth month postoperative photographs of frontal view of the patients were evaluated by Adobe Photoshop CS5. Various soft tissue measurements were performed and proportional relationships between (i) eye width-intercanthal distance, (ii) the distance between right and left medial limbus-mouth width, (iii) intercanthal width-alar base, (iv) interpupillary distance–distance from nasion (N) to labrale superius and (v) sclera exposure of eye–eye height were determined. Proportional relationships of preoperative and postoperative facial view were statistically analyzed.

Result: The proportion of sclera exposure decreased from 0.1 to 0.02 ( p = 0.001) for both eyes symmetrically following 6.1 (± 1.8) mm maxillary advancement and 2.97 (± 1.1) mm impaction. There was statistically significant difference between eye width and intercanthal distance before the surgery ( p = 0.004), whereas the difference was not significant following surgery in Group I. The proportion between interpupillary distance and distance from N to labrale superius approximated to the norm ( p = 0.006) following the surgery in Group II. The change of proportion of intercanthal width and alar base was not statistically significant for both groups.

Conclusion: Sclera exposure in patients with midfacial retrusion decreases significantly following maxillary advancement and/or impaction procedures and orbital proportions approximated to ideal norm.

Key words: sclera exposure; orbital region; Le Fort I; maxillary advancement; midfacial retrusion