Q: Dr. Eppley, I have orbital dystopia that I want corrected. Here are a few photos and you can see that my left eye is noticeably lower on my face. As you may also notice from the top view, you can see that the left eye also protrudes forward a bit. My nose and chin also are off the center line and lean to the left as well but my eyes have always bothered me the most and the others I can live with. Again, this is something that has made things difficult for me and i’ve just reserved myself to the idea that I have gone this long and I may as well just live with it….until I shaved my head due to hair loss that is. Now my eyes are the very first thing that people notice and they stand out much more now. Any thoughts/guidance would be much appreciated.
A: I have seen your photos and the amount of orbital dystopia in the left eye seems to be about 2 to 3mms at most. That can be improved with frontal orbital floor augmentation and possibly orbital rim augmentation as well. That will bring up the vertical level of the eye but it will not change the more forward projection of the eye as seen from the top view. The key question in any case of orbital dystopia is what happens with the position of the lower eyelid for that is not a bone-based structure and thus will not change. With the eye coming up and if the lower eyelid position remains the same, some slight amount of increased scleral show may result. That is why a canthopexy is usually done to provide a bit of lower lid tightening/lift as well with the change in eyeball position.
Dr. Barry Eppley