What Are The Procedures Needed To Correct Vertical Orbital Dystopia?
Q: Dr. Eppley, what are the procedures needed to correct vertical orbital dystopia? Will just putting an implant under the eye alone work?
A: I use a 6 step approach to VOD correction. Step 1 = placement of custom orbital floor-rim implant to raise the eyeball up. Step 2 = transpalpebral brow bone reduction to raise up the lower than normal tail of the brow bone. Step 3 = drill hole lateral canthoplasty to raise up the lower eye corner position. Step 4 = transpalpebral brow lift to raise up the lower eyebrow through the upper eyelid in the bald/shaved head male where traditional browlifting techniques are not good options, otherwise an endoscopic browlift technique is used, Step 5 = spacer graft to the lower eyelid to support the middle part of the lower eyelid in a more upward position. Step 6 Upper eyelid ptosis repair, needed as the eyeball moves but the position of the upper eyelid will remain the same if not treated.
This comprehensive approach to VOD is necessary as just raising the eyeball alone will create other undesired changes around it if the posiions of the eyelids/eyebrows are not addressed. It would be like raising the window frame but keeping the shades in the same place. It is easy to get focused on the custom implant because it takes more than that to imporove the overall eye asymmetry.
Dr. Barry Eppley