Q: Dr. Eppley, What can be the most likely solution to my bulging eyes? You can see in my pictures that my eyes stick out. They have been this way since I was little girl.
A: Thank you for sending your pictures. The first question to answer is whether this is exophthalmos due to a medical condition such as hyperthyroidism. But since your eyes have always been ‘buggy’ it would be reasonable to assume that this is their natural appearance. It looks like you have what is known as pseudoproptosis. (appears like eye bulging when in fact it is not) This is due to a lack of bony rim/fullness around the eye particularly in the superior and lateral orbital rim areas. When the bony rims are recessed or not adequately projected the eyeball will look like it is sticking out when in fact its position is normal within the orbital box. The fact that they have been this way your whole life would support that this is just the way your face developed. Placing custom made superior and lateral orbital rim implants through an eyelid incision or doing it from above through a scalp incision would be the only way to improve this bulging eye appearance.
Dr. Barry Eppley
Q: Dr. Eppley, I’ve attached a photo of my side profiles and front. The main issue I have is with my eyes, which effects my self esteem the most. They also protrude quite a bit and I was hoping orbital decompression could be done whilst aligning them? I know it’s a very complicated invasive procedure.
The others issues are my jaw, hairline and eyebrows. I clench my jaw (whilst sleeping) predominantly on the left side resulting in having to get a root canals to subside pain in those teeth. So it’s more function than anything.
If it’s possible to get the alignment sorted out, I would possibly at a later stage want augmentation done on my jaw and cheekbones to balance my face out. What would your opinion be on that? Thanks again, your time is very much appreciated.
A: Thank you for your inquiry. You are making an incorrect eye diagnosis. You do not have true orbital proptosis or bulging eyes. You have pseudoproptosis…meaning the eyes appear bulging because the orbital bones around them (infraorbital rim and cheek bones) are deficient. Thus the eyes appear bulging when in fact the eyeball has a normal position. Thus orbital decompression surgery is an incorrect and inappropriate treatment for you. The correct treatment is to build up the underlyling bones which are deficient through onlay facial implant augmentation.
In regards to other issues, Botox injections are the ideal treatment for painful masseteric muscle clenching, which can work spectacularly well.
Dr. Barry Eppley
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.