Do I Need an Orbital Box Osteotomy To Fix My Orbital Dystopia?

Q: Dr. Eppley, I am looking to fix my severe orbital dystopia among other glaring obvious asymmetries (chin, nose, cheeks, etc.) that make me look unusual, extremely asymmetric/unattractive. I believe that these asymmetries are congenital (it has been suggested that I was born with a mild hemifacial microsomia). I am extremely depressed about my appearance and it is worsening as I am aging. I am working with a surgeon who was going to perform a OBO, but decided that, after virtual surgical planning, the vertical mm’s I would gain weren’t worth the hassle of the surgery. Now, the plan is to appeal with insurance to get an orbital implant placed. I received the “after” morphs of what that could look like and am upset that, even with the implant, there will likely not be much of an improvement on the orbital dystopia (and the medial canthus would remain at the low placement it is currently sitting at). I am hoping to see what you have to say about this situation.

A: The answer to your question in my experience is that you need an OBO. No non-OBO procedure is going to make much of a difference in your case. As a general rule non-OBO VOD procedures are indicated when the VOD is 5mms or less. Any amount greater than 5mms needs an OBO procedure.

Why your surgeon won’t do the procedure I can not say but he likely was trying to do it without a frontal craniotomy…which is not going to work.

Dr. Barry Eppley

World-Renowned Plastic Surgeon