What Is The Best Method To Correct The Vertical Orbital Dystopia Of My Facial Asymmetry?
Q: Dr. Eppley, I think that the most prominent issue is the lower eye however I think that the right cheek is also “flatter” because the right malar bone is not as prominent or is smaller or “set back”. I also think that the hypoplastic bone structure extends to the top right of the skull. For instance, the top right of my forehead doesn’t match the top left.
The point about a flatter cheek on one side wouldn’t show as much I think from a front on photo.
So I think skull reshaping may also be required in addition to any work on the face.
In terms of the question about what was done previously. This was cheek and brow augmentation I think using a bone cement called hydroxyapatite. I was operated on by two surgeons during one operation. One doing the bone augmentation, the second an eye surgeon specialist did left and right blepharoplasties and a right canthal suspension to raise the canthus of the right eye higher up the face.
There was a fat prolapse under the eyes and this also contributed to the appearance of asymmetry.
The brow and cheek augmentation was the cheaper of two treatment options presented to me and was the only one I could afford at the time. The second, more expensive option would have required the production of a custom “implant” that would have augmented the hypoplastic bone more generally in the face and skull.
Obviously I am only a layman but I think with the approach that I opted for the results cannot be guaranteed and of course only augmented the cheek and brow bone in an attempt to reduce the appearance of the asymmetry as opposed to generally correcting it.
The other approach with the “implant” (I’m not sure that is an accurate word for it) designed based upon analysis of scans of the skull would have fixed the issue more generally and I think the results of how it would change the bones near the eye are probably more accurately predictable.
A: Thank you for your detailed response. Your biggest component of your facial asymmetry has always been your VOD. (vertical orbital dysopia) which affects more than just the position of the eyeball. With a lower orbital box the brow bone/forehead/skull is pulled down and the cheek is flatter that side. That is all consistent with the VOD.
Your are correct in that your original facial asymmetry surgery was a patchwork approach to the problem, which helped, but predictably left it uncorrected as the solution did not ideally match the problem. You are also correct in that using a 3D CT scan the fuller extent of the bony problem can be addressed to provide the supportive foundation. Your prior lateral canthoplasty is a good example of just pulling up the soft tissues without underlying bone support results in less than optimal result and one that is not well maintained.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.