In Vertical Orbital Dystopia Can The Higher Eye Be Lowered?

Q: Dr. Eppley, With vertical orbital dystopia, is it possible to lower the eye that is situated higher if one prefers the appearance of the lower eye/mid face or is such an approach impossible? The infraorbital bone would have to be shaved down I assume but placing an implant superiorly above the globe would probably involve greater health risks. Are nerve damage and vision problems likely complications with these kinds of procedures? I suspect my dystopia would be in the 5mm range. It really ruins facial harmony and I noticed people that are widely considered attractive almost always have either none or very little eye asymmetry. Is it possible to receive a quote for a possible surgery assuming it would involve cheek and eyelid work as well? (the sides of my face are asymmetrical across the entire face)

A: To lower a higher eye that is done by dropping down the bony orbital floor like is done in orbital decompression surgery. This is not a precision procedure, like raising the eye with a premade implant, so exact amounts of lowering are hard to predict. Besides that issue the more pertinent concern is that the position of the upper eyelid will remain the same when the eyeball lowers…affecting the lid-globe relationship. Unlike raising the eye where the upper eyelid can be surgically raised by ptosis type procedures to restore the lid-globe relationship, there is no surgical procedure to lower an upper eyelid. Thus another aesthetic problem may result with too much scleral show between the upper eyelid margin and the superior margin of the iris.

I would need to see a picture of your eye asymmetry to determine how these potential issues may apply to you.

Dr. Barry Eppley

Indianapolis, Indiana