What Is The Best Approach To Treating Eye Asymmetry?

Q: Dr. Eppley, I understand that the most common approach to treating VOD involves an orbital floor implant. I also note that he mentioned that performing a floor implant would likely require repositioning of both the upper and lower eyelids.

A:An orbital floor implant is the easiest and most predictable part of VOD surgery. However,  it alone rarely addresses the problem and is just a part of the solution but not the complete one. If you just lift up the eyeball and don’t change the brow and eyelids around it you actually make the problem worse by burying  the eyeball underneath the upper eyelid and increasing scleral show on the lower eyelids. Therefore, in almost every case of VOD you have to go ‘all the way’ to obtain a result where all the components fit together in for a more symmetric and natural looking result. This means, besides the orbital floor implant, the upper and lower eyelids need to be repositioned as well as a brow lift on that side.

In addition it will not change the position of the medial canthi although the inner eye corner at the junction of the skin and lacrimal lake can be adjusted for that.

Therefore, as you can now appreciate one has to make the decision as to whether it is best to leave the asymmetry alone or go all in and have the maximal surgery. for it.. with the understanding that the degree of eye symmetry will be reduced but will never have perfect symmetry to that of the opposite eye.

Dr. Barry Eppley

World-Renowned Plastic Surgeon