How Can I Improve My Eye and Facial Asymmetries?

Q: Dr. Eppley, I have very noticeable eye/overall facial asymmetry and have asked a few surgeons about a brow lift + blepharoplasty to address this but it doesn’t seem realistic. Would a custom implant be able to fix this? 

A: Thank you for your inquiry and sending your picture. You are correct in that a browlift and upper blepharoplasty would not only not correct your eye asymmetry but would make it appear worse.

You have to think of vertical orbital dystopia (VOD) as a composite bony and soft tissue box which all must be dealt with as a unit. You can’t just treat one component of the orbital box and have it look right…I wish it was that simple but it is not. While the eye can be raised up considerations have to be given to the brow bone above it as well as the overlying soft tissues (upper and lower eyelids and eyebrow) and how they must be managed to follow and/or drape around the new eyeball position. 

Most VODs of significance, and yours would certainly qualify (greater than a 3mm difference in the horizontal pupillary line), need a complete orbital box management approach. The question then becomes how effective would the surgery be in terms of achieving improved or optimal horizontal pupillary line alignment. This assessment first begins by getting a 3D CT scan of your face to have a complete understanding of the bony differences in shape and position between the two sides. This not only provides valuable diagnostic information but is used for treatment planning as well.

Dr. Barry Eppley

Indianapolis, Indiana