Can Orbital Box Osteotomies Be Done In An Adult for Aesthetic IPD Correction?

Q: Dr. Eppley, I’m reaching out after reading your material on orbital box osteotomies and orbital translocation for interorbital distance correction. I’m specifically interested in understanding whether a procedure to reduce intercanthal/orbital distance (bringing the eyes closer together) is ever performed for aesthetic cases rather than congenital hypertelorism. I had a few questions: • Do you perform orbital box osteotomies or any form of orbital translocation in adult patients for aesthetic concerns? • What criteria determine candidacy for this type of procedure? • What imaging (CT scans, 3D analysis, etc.) would be required to evaluate feasibility? • What are the primary risks, especially regarding vision, nerve function, and long-term structural stability? • What does the recovery timeline typically look like for a procedure of this magnitude? • In cases where full orbital translocation is not appropriate, what alternative procedures can create the appearance of reduced eye spacing (e.g., medial canthus modification, nasal bridge augmentation, or surrounding structural changes)? I understand this is a major craniofacial operation with significant tradeoffs, and I’m looking for an honest assessment of whether this is realistic or if alternative approaches would be recommended. Thank you for your time.

A:Full 360° orbital box osteotomies are rarely, if ever, performed for purely aesthetic purposes given the magnitude of the surgery and that the risk versus benefit trade-offs may not be a good one.

This relegates the aesthetic patient to considering subcranial lesser degree orbital box changes, often called inferior or 180/270° orbital box osteotomies. While this may have some merit in the patient who wants to increase their interpupillary distance (IPD) it would be ineffective in the patient who wants to decrease their IPD as this requires expansion of the inner orbital walls which the lesser orbital box osteotomies can not do.

When it comes to camouflage approaches nasal augmentation will make the eyes look closer together rather than further apart. The only other camouflage approach is to lengthen or decrease the lacrimal lake area at the inner eyes a few millimeters on each side depending upon a closer or further apart look..

Dr. Barry Eppley

Plastic Surgeon