Can Modified Orbital Box Osteotomies Increase The Interpupillary Distance By 6 to 8 Millimeters?

Q: Dr. Eppley, According to what I have seen in several web pages the orbital box osteotomy is the only way to separate the eyes. As I have seen this operation is very complex, so I was wondering if you do it in patients with close eyes but within normal parameters, simply for cosmetic reasons. I mean adding 6-8 millimeters between both pupils, making the inner canthal distance about 6 millimeters wider. 

A: It is not a question or whether orbital box osteotomies can be done in someone with ‘normal parameters’, but it how it should be approached. Doing traditional orbital box osteotomies using a coronal scalp incision and a frontal craniotomy seems to be a mismatch between the magnitude of the problem and the solution. A more acceptable approach, where the surgery seems better matched for the problem is a modified orbital box osteotomies which avoids a coronal scalp incision and a frontal craniotomy. Going through the combined approach of lower eyelid and intraoral incisions only the interpupillary distance can be increased by 3 to 4mms per side.

Dr. Barry Eppley

World-Renowned Plastic Surgeon