Can Vertical Orbital Dystopia Be Fully Or Only Partially Corrected?
Q: Dr. Eppley, I’m strongly considering going ahead with the cheek implant and vertical orbital dystopia (VOD) correction this year. I have a few important questions.
1) You said we can address the VOD at the same time as the cheek implants. I’m still deciding if I should do that, or just the cheek. Based on measurements on the CT scan/implant design, I guessed that my right eye socket and cheek are approximately 2mm lower. Could you possibly look at my CT and tell me the exact amount of this asymmetry?
2) It is possible to mitigate the eye asymmetry rather than completely correct it? Because my right brow is also lower, I’m concerned about the effect of pushing my eye up without pushing the brow bone up. I’m wondering if “something in between” might be a better solution? Half the current eye asymmetry will not be perfect, but it will likely be unnoticeable.
3) Is there a significant chance I will need more revisions on the eye structures? Or could this go wrong and create a negative outcome? To me (as a non-expert) it seems quite complicated to adjust the eyelid (ptosis repair), adjust the lower eyelid, and the position of the eye, all in unison.
4) How hard is it to get the cheek implants properly placed compared to the jaw implants? I.e. what is the chace I will also need a revision of these?
A: In answer to your questions:
1) In looking at your 3D CT scan, it was taken just high enough up that it includes the woes half of the orbits which is sufficient for vertical orbital dystopia (VOD) assessment and implant design. It is evident that the right orbital floor and infraorbital rim is lower and I would estimate that 2.0 to 2.5mm is the amount. That would correspond with what is seen externally. (see attached)
2) You are correct in that in the treatment of VOD one has to always consider the position of the overlying structures of the upper eyelid and brow bone as you don’t want the eye to become buried under the upper eyelid or look disproportionate to the brow bone. But more commonly the aesthetic ‘culprit’ that must be considered is that of the lower eyelid. Increased scleral show (iris moves up but the horizontal lower lid level remains the same) will always be more easily seen. This is addressed by both elevation of the infraorbital rim by the implant design as well as a lateral canthopexy and possibly lower eyelid spacer graft.
3) In my experience about 30% of VOD surgery patients undergo a revision of one of the eyelids later. But that depends on the extent of the original problem and the magnitude of the surgery done to treat it.
4) Orbital, cheek and combined orbital-cheek implants have a lower rate of implant revision because of more direct visualization of their placement.
Dr. Barry Eppley