Your Questions

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: D. Eppley, I am a 30 year old and have had prominent eyes that are congenital but not hereditary. I have no medical problems and the thyroid readings are normal. My eyesight is very good. I have a negative vector and shallow orbits . Will I need both cheek and orbital implants? Could you please give me an idea of the nature of the implants before I come down to your clinic. Thanks

A: When one has pseudoproptosis (eyes that appear to bulge out but actually are normal in position but the bone around them is deficient), the consideration of orbital rim augmentation with implants is a reasonable one. Whether the orbital rim or the rim and the cheek needs to be built up is a matter of one’s anatomy. In most cases, significant orbital; rim hypoplasia is accompanied with an underdeveloped cheek as well. This is where the use of a combined orbito-malar implant can be most beneficial.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hello Dr Eppley. I have several issues about my face that I would like changed. I am a 21 year old female with prominent eyes along with an oblong face shape. My eyes are not bulging out but they are just prominent. I have no cheek bones. It must just come with having a longer face shape I guess and I lack fat below lower eyelids. I was considering a mini face lift to make my eyes less prominent and my face look less tired. But as I have researched it’s too early to get it done at my age. What options do I have? What would you recommend in order to make my eyes look less prominent and get some volume on my face to get rid of the tired look and make my face look fuller (rounder).

I’m sorry for the long question but I’m so excited to come across your site since I see that you are experienced in almost all areas of cosmetic surgeries.

A: By your description, it appears that you have a longer but flatter face. Flatter in the face refers to a recessed development of the midface, particularly the zygomatic-orbital skeletal areas. (midface, cheek and lower eye socket bones) This lack of anterior projection makes a face appear longer, particularly if the vertical height of the face is long to start with. This also accounts for the lack of fullness in the lower eyelids (sunken in appearance) and the apparent big size of the eyes.

While your eyes may be big in size and your face long, the lack of cheek and lower orbital rim bones can really accentuate that appearance. Improvement of midface deficiency at this level is done by the use of cheek and orbital implants, specifically a combined infraorbital rim-malar implant. This provides fullness across this deficient bony area and provides some horizontal projection. (fullness) This helps balance the face better, make it look a little shorter and can help make the eyes look a little less prominent. These implants are placed through a lower eyelid incision.

Any form of a facelift is exactly what you don’t want to do. This is not a skin problem but a bone-based issue.

Dr. Barry Eppley

Indianapolis Indiana