To Address My Lower Right Eyebrow Should I Try And Drop Down The Higher Left Side?

Q: Dr. Eppley, Hello, I wanted to ask a question about facial asymmetry and possible procedures to address it. On one side of my face, my eye sits lower, along with the eyebrow, eyelid, and cheekbone. I was wondering which procedure would be best to correct this. I’ve read about combining an orbital rim implant with a cheek implant. However, I’m concerned that if the eye is raised with an orbital rim implant, the eyebrow and eyelid—since they are already lower—might appear more covered. In that case, I understand that an eyebrow lift might also be needed to bring the eyebrow and eyelid to the same level as the other side. This approach could make the eye and cheekbone more symmetrical, but the eyebrows might still be uneven. That led me to wonder whether fat transfer to the opposite eyebrow and eyelid could be an option. By adding volume to that side, it might lower the eyebrow slightly and help both eyebrows and eyelids sit at the same level. Is that something that would be possible?

A:What you are describing is classic vertical orbital dystopia, which means the entire orbital box in all of the soft tissues around it are low. As you have correctly surmised correcting the orbital floor, rim and cheek bone positioning by a custom-made implant is not the total solution to the problem. In fact that alone will likely make it look more apparent because you have to change all the soft tissues around it including  the upper and lower eyelids as well as the eyebrow. to look right with the implant induced changes. Thus  most cases of vertical orbital dystopia surgery must be comprehensive of which the implant is but one part of it.

Fat grafting of the opposite eyelid is not going to make it lower. It will merely make it look fuller. As a general rule for almost all cases of any type of facial asymmetry you do not usually try to improve it by changing the good side. That being said this is a general guideline of which how about exactly replies to you is unknown since I’ve never seen a picture of your eye asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon