The Importance of Cheek Position
In most people, the front of the eye lies either behind or in line with the most forward projection of the cheek (shown by the curved arrows). This situation is called a “positive vector” and indicates good support for the lower eyelid. If the forward most part of the cheek lies behind the eye, this is called a “negative vector” and has several implications. First, the lower eyelid may be poorly supported, causing it to droop, exposing white beneath the colored part of the eye (so called “lower eyelid retraction”) which may in turn create or worsen dry eye symptoms. Second, a receded cheek or mid-face may create a gaunt or sallow impression or the appearance of bulging eyes. Third, lower eyelid surgery or a face lift must be very carefully planned and conducted to avoid serious eye exposure complications.