Your Questions

Q: Dr. Eppley, I have an eye problem. My right eye is lower than my left by a few millimeters, I can tell because when I look straight in the mirror it looks lower as judged by the level of the pupil. I got punched in the face about five years around broke some bones around my eye but never had surgery. They said it wasn’t bad enough to have surgery at the time. But my eye has slowly sunk down over time. Is there a way to fix this?

A: What you have is called enophthalmos where the eyeball has dropped lower due to lack of bone support or fat support underneath. Most likely you had an orbital floor fracture which was not significantly displaced so surgery to fix it was not done at the time. But over time, fat atrophy may have occurred which is another well known cause of enophthalmos after such floor fractures. The best approach is to build the floor back up with a synthetic orbital floor implant. The question is whether you have enoughenophthalmos to justifiy the surgery. But then you likely would not be asking me about it if it was irrelevant to you. If done through a transconjunctival approach then the procedure would not create any new skin scars. The risks of such surgery would be persistent undercorrection, overcorrection, implant shifting and potential infection. The aesthetic side of these risks are more likely.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I have a facial asymmetry problem. Even though I know that everyone has a little asymmetry to their face, mine is not that little. It is quite visible. My cheek bone on the right is a little higher than that of the left. So is the eyeball area above it. I also don’t like my very bushy eyebrows and my left eyebrfow is lower than my right side. My left ear is lower than my right one and that makes it difficult to wear glasses or sunglasses comfortably. I am attaching a frontal picture for your assessment and recommendations. I am leaving this up to you as there seem to be few doctors that know how to treat facial asymmetry and because of your good reviews plus you can help me in all my problems.

A: Thank you for sending your picture and expressing your specific concerns. Your overall issue is one of facial asymmetry with the left orbito-maxillary region as a unit being lower on the left side. The lower positioned left ear would be part of that overall problem. As a general concept to gain better facial symmetry, the lower facial side has to be raised rather than trying to lower the higher side as that is surgically more possible.

With the objective of raising the left sided facial issue, I would make the following recommendations/thoughts. The left ear could be raised somewhat through suspension sutures from the cartilage to the fascia. A slight setback of its protrusion (sticking out) may be considered. This would be done through an incision on the back of the ear. A left eyebrow lift could be through an upper eyelid approach (transpalpebral browlift) which is the most common approach in men. I would remove a slight amount of left upper eyelid skin (blepharoplasty) which also serves as the access for the browlift. The lower eyelid marginj could be raised slightly on the outside with a lateral canthopexy/lid wedge excision. Raising the eyeball, even a few millimeters, can be difficult but a small orbital floor implant could be placed for a slight lifting effect. A small cheek implant would be used to provide some upper cheek fullness. Eyebrow waxing can be done to reduce fullness and are a good start to determine if their thinning is aesthetically advantageous. If so, you can then consider laser hair removal which is best done locally due to the need for a series of regularly spaced treatments to get some permanent reduction.

Although all of the individual surgeries are small in nature, they can collectively make a noticeable difference. All os this is said with the understanding that your facial asymmetry can be improved but a perfect match to the right side is not possible.

Dr. Barry Eppley

Indianapolis, Indiana