Can Orbital Box Osteotomies Be Done To Increase Intercanthal Distance?

Q: Dr. Eppley, I have an aesthetic eye spacing concern. I believe my eyes are positioned too close together in proportion to the rest of my face. It is something that has bothered me for a very long time and I am willing to do whatever it takes to find a solution.

Through my own research I have realized that increasing intercanthal or interorbital distance can seemingly only be achieved through highly invasive and expensive craniofacial procedure that would undoubtedly have many aesthetic trade offs of its own. Widening of the nose bridge, full coronal scar and bony step offs seem to be the most significant. Even in consideration of these trade offs, I still feel as though I could benefit from this procedure.

I would first like to know whether it is even possible to achieve such a movement of the orbits (3-6mm) with a high enough degree of accuracy and predictability? If so, is it plausible that a cosmetic patient could undergo the procedure if they were both well informed and highly motivated? I can send pictures for evaluation if it would be helpful.

I just find it very hard to accept that my biggest and most detrimental perceived flaw seems to be one of the only things that does not have an easy cosmetic fix.


A: The issue is not whether orbital box osteotomies can be performed to increase intercanthal  distance by 3 to 6mms, because you can, but whether the aesthetic tradeoffs you have mentioned and the magnitude of the procedure (a frontal craniotomy is needed) and its cost could be justified for that type of aesthetic eye change. It would be hard for me to imagine that it would.

Dr. Barry Eppley

Indianapolis, Indiana