Q: Dr. Eppley, What if anything can be done for my orbital and overall facial asymmetry? Its clearly affected the entire side of my face not just my eye. I have to tilt my face for pictures and even then its way off. Thoughts? The second pic is with my head tilted…I am tired of having to do so and has really hindered my confidence my entire life.
A: Thank you for your inquiry and sending your picture. Eye asymmetry (orbital dystopia) rarely occurs in isolation and is often part of an overall facial asymmetry. The brow bone, cheek, nose and even the jawline may be lower or deficient on the ‘lower eye’ side. Tilting the head helps ‘lift’ the deficient side to make it more even. The key is this type of facial asymmetry is to pick the procedures that would make the greatest difference. The hardest choice is deciding what to do with the eye as this is the most important part of the facial asymmetry correction. The eye must come up as well as the outer corner of the lower eyelid. One caution here is to keep an ‘eye’ on the position of the upper eyelid so the raised eye does not get buried under the upper eyelid creating a pseudoptosis appearance.
Vertical brow bone reduction, cheek augmentation and jawline reduction/widening and a straightening rhinoplasty are all other options to consider in facial asymmetry correction.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in eye asymmetry surgery. A few months ago I fainted and fell against a sink. The result was a left eye broken orbit (only the rim below, not a blow out fracture, no displacement). After a few weeks when the swelling was gone, I saw that the position of my left eye was different from the right side. Doctors measured a different of the position of the globe of 1.5 mm. Although it might not be much, in my case it is obvious. Doctors told me that it could be from fat atrophy. Do you think that an implant or so can help me to get my eyes more symmetric again? Many thanks for your response!
A: If an eye asymmetry has indeed developed after some type of orbital fracture, particularly if occurring within the first month after the injury, I would have it assume that this is due to a skeletal issue not fat atrophy. (as that would take many months or even years to be seen) But regardless of its cause a horizontal globe asymmetry can be treated by one of two methods, an implant or fat grafting. A small implant can be used to build up the orbital floor or a dermal-fat graft can also be so placed. (if you happen to have a c-section from your children) This is a simple surgery in which either material can be placed through a limited subciliary or transconjuncitival incision. The hard part is just deciding if such surgery is absolutely necessary and what material to use in doing it should it be so. Please send me a picture of your eyes showing their current state.
Dr. Barry Eppley
Q: Dr. Eppley, what can be done about my eye asymmetry? My whole left eye is about 5mms lower than that of my right eye. What is the best way to amend this problem?
A: To correct your orbital box eye asymmetry, multiple adjustments need to be made to the orbital floor (augmentation), brow bone (inferior reduction) as well as upper eyelid (ptosis repair) and lower eyelid (fat injections and lateral canthoplasty) The issue is that the bone changes will cause problems with the current eyelid positions and then these will need to be adjusted. I have treated many cases like yours and sometimes you open ‘pandora’s box’ by trying to make these changes. The position of the eyelids is perfectly aligned to the bony orbital skeleton now albeit lower and asymmetric that it is. Once changes get made to the orbital bony box, the eyelids will be off alignment to the globe (eyeball) and these realignments often take multiple surgeries to get the optimal result.
Once the horizontal level of the pupils differs by 5mms or more in eye asymmetry, attempts at surgical improvement are often met with mixed results and lead to multiple revisional procedures.
Dr. Barry Eppley