How Can My Left Eye Be Lowered To Match Better To My Right Eye?

Q: Dr. Eppley, I have two different eyeball heights. I think that lowering the left eye to the right eye’s height would make for a better look. It creates a better FWHR ratio from the lowered eye height. It is pretty invasive but it is worth it.

A:Then you are referring to a left orbital decompression procedure in which the orbital floor is dropped anteriorly which will make the eye drop down a bit. Be aware of two things in regards to unilateral orbital decompression:

1) It is not completely predictable/controllable in terms of how much globe drop may occur., In words it is not 1:1 in terms of how much the bony floor is lowered vs how much the eyeball drops. You have to know that orbital decompression was developed in thyroid eye disease for extremely bulgy eyes in which both sides are treated similarly. When applied to aesthetic vertical orbital dystopia (VOD) it now becomes a unilateral procedure in which a very specific target I(e.g., 3mms of pupillary line discrepancy) is sought and by which the result can be very critically assessed. (the opposite desired eye position) In short this is really a ‘macro’ procedure being used for a ‘micro’ outcome….which means perfectly symmetric eye levels is nit likely be achoved. Better…yes, perfect….no.

2) As the eyeball is lowered the upper and lower eyelid positions do not change. Thus the relationship between the lid levels and the iris will change. (lower lashline moves up on iris closer to the pupil and the upper eyelid moves up on the iris away from the pupil. Unlike elevating the eyeball where lids can be adjusted upward as needed, when lower the eyeball there is not good way to adjust the eyelids downward.

Dr. Barry Eppley

World-Renowned Plastic Surgeon