How Is Orbital Floor Augmentation Done?
Q: Dr. Eppley, I am seeking orbital floor augmentation. I have a mild case of orbital dystopia of my left eye. It is about 2mms as judging by the position of iris of the eye to the lower eyelid compared to the other side. How would orbital floor augmentation be done. Would there be any external scarring?
A: There are numerous options of how to do orbital floor augmentation. There are two choices to make in orbital floor augmentation, incisional access and the choice of augmentation material. Because your orbital dystopia problem is fairly slight (1 to 2mms), your young age, and your asian skin, I am loathe to consider any type of open procedure that involves an external lower blepharoplasty incision. While that is how I would normally do it, I just don’t think your amount of orbital floor augmentation justifies that degree of invasive surgery. That leaves either a transconjuncival approach or a purely injectable technique. Because it is the eyeball and for safety purposes, I would not do an injectable method. That leaves us with the transconjunctival approach. (internal eyelid) The next issue is the augmentation material. This is a choice between a natural material (like fat or cartilage) or a synthetic implant. This is a classic debate in orbital floor augmentation and just about anything will work. It just depends on your thoughts of a graft harvest (ear cartilage or fat harvest) or a synthetic material. (like a bone cement or gore-tex (PTFE) floor implant. There is also the issue of how much access the transconjunctival approach offers and the ability to get the augmentation material through it.
Dr. Barry Eppley