Q: Dr. Eppley, I am interested in a unique form of brow bone reduction/reshaping. I am wondering if you can reshape the bone on the lateral superior side of my orbital rim through osteotomy. I was only able to find one instance of this procedure in medical journals. I have attached the article below and I have also attached photos of my current eyes and what I would like my eyes to look like after the procedure. I am also interested in forehead augmentation especially on the lateral sides but that is not something that is as important right now and can be discussed later. I am not concerned much about scars as long as I can hide them with fairly long hair. This is because without an eyelid crease, I get ptosis and the current eyelid crease is causing much discomfort.
A: You obviously have researched out the need/benefits of a lateral superior rim orbitectomy/reshaping procedure (variation of brow bone reduction) so the issue of whether it is of benefit to you I will bypass over.
I have performed this procedure several times and it is the ‘simplest’ form of brow bone reshaping/orbital rim modification that I know. This is because it is done through an upper eyelid incision (as opposed to most brow bone procedures which is done through a scalp or coronal incision) and the frontal sinus or intracranial contents are not close to this area so the bone is thick and can be aggressively reduced. So it can be very successfully done just as you have shown in this ‘ancient’ Plastic and Reconstructive Surgery article.
The only caveat in an Asian patient like yourself is that I would have some potential concerns about using an eyelid incision due to adverse scarring and in the face of pre-sexisting ptosis. In addition, if you have an interest/need for forehead augmentation, this would be another reason to consider coming from above, addressing two problems simultaneously.
Dr. Barry Eppley