Q: Dr. Eppley, I would like to know the differences in the frontal view after orbital decompression and brow bone augmentation? I would like to get deeper set eyes but I know decompressions has a lot of side effects. Do you have photos of before after to show for brow bone augmentation? Thank you
A: Orbital decompression will not produce deep set eyes in a normal patient. While orbital decompression is effective for the patient with protruding eyes (exophthalmos), this is because it is an abnormal protrusion and dropping out the orbital floor bone will give the enlarged eye a space to fall back into. In the normal non-enlarged eye, dropping the orbital floor will only make the eyeball fall lower and not back. Thus in the frontal view, the eyeball may look lower and the pupil drops down closer to the lower eyelid margin. Conversely, brow bone augmentation combined with lateral orbital rim augmentation will make the eye look deep because it moves the bony rims around it further forward. This can be shown by looking at before and after pictures of brow bone/forehead augmentation which can be seen on my website in the Facial Reshaping section under those specific procedures.
Dr. Barry Eppley
Q: Dr. Eppley, I wonder if my deep set eyes can be treated by the same procedure which is done for enophthalmos? I heard from a doctor that cartilage can be implanted behind the eyeball. Is that possible?
A: Building up the orbital floor with any form of a graft works in enophthalmos because there exists expanded intraorbital volume and the graft is merely returning the intraorbital space to normal. The eyeball can be oushed up and out because there is space for it to go. where it was once was. In a normal or non-enophthalmic eye, there is normal intraorbital space and lessening that with a graft runs the risk of putting pressure on the eyeball. In other words, you are not going to push the eye out by putting in a graft without the potential risk of visual impairment.
Dr. Barry Eppley