Q: Dr. Eppley, I am an 37 Asian male with very prominent bulging eyes (I believe it is due to having a relatively flat skull with shallow eye sockets). From a side profile view, my eyes protrude farther than my nasal bridge. To my knowledge, I have never had Graves disease or any other eye condition other than myopia. I think it is simply a genetic aesthetic condition. But it seems to me that browbone augmentation could be an ideal way to reduce the prominence of my eyes. I can send you pictures I have taken of my eyes from different angles. I would like to know if I am a candidate for this surgery. Thank you!
A: What you are referring to is known as pseudoproptosis, the eyes appear to stick out because the surrounding bones are underdeveloped or not string enough. I think it is true that brow augmentation would be beneficial. But one may also consider lateral and inferior orbital rim augmentation as well (and maybe nasal augmentation) to provide a more complete orbito-malar augmentation to more effectively produce a less ‘bulging’ eye. This type of midfacial skeletal hypoplasia is very common in Asian patients as brow and forehead augmentation are frequent aesthetic procedures considered with this type of craniofacial skeletal development.
Q: Dr. Eppley, if I was to have a rhinoplasty to augment the bridge of my nose and a forehead/eyebrow augmentation, which should be done first? Will having the raising of the nose bridge first and then the forehead/ brow augmentation mess up the profile of the nose together with the brow ? Which procedures should I do first for best results ? Does it make a difference ?
A: I think the best aesthetic sequence is to do the forehead before the rhinoplasty. That way the position of the nasal implant can be optimized to that of the frontonasal level of the brow augmentation. That is a lot easier to do than the other way around. Getting a significant augmentation of the brow, particularly in the glabellar area, is more difficult that just forehead augmentation where you leave the brow area alone. Once a forehead/brow augmentation is done it is very difficult to change particularly if you are trying to add more to the brow or glabellar area. Therefore, create whatever brow/forehead augmentation that can be done and then set the level of the nasal bridge to that. In essence, work your way down from the top based on the difficulty of doing the procedure. When brow augmentation and rhinoplasty is done at the same time, it is easier to make both meet in the ‘middle’ so to speak.
Dr. Barry Eppley