What Procedures Do I Need To Correct Vertical Orbital Dystopia?
Q: Dr. Eppley, Hi! I’m pretty sure I have Vertical Orbital Dystopia as you can see in the picture. Saying this bothers me would be a huge understatement, I’m 20 years old (no health issues), haven’t been in a picture for at least 8 years and can’t look at someone in the eyes because I’m ashamed. I’m desperate to fix this. Obviously I’m not looking for perfect symmetry, but I want to have “normal” asymmetric eye. Seeing all the pictures on your website, I’m really interested and would like to know how much this could cost me and if this is a dangerous procedure. Thank you!
A:Thank you for your inquiry and sending your picture. Your diagnosis is correct (vertical orbital dystopia, VOD) and its magnitude is aesthetically significant. (probably 5mms) The entire right orbital box is lower. This means the brow bone and cheek around the eye are part of the skeletal asymmetry and must be included in the treatment approach. While a preoperative 3D CT scan is needed for proper treatment planning, the concept besides raising up the floor of the eye is that the brow bone above needs to be vertically reduced and the infraorbital rim and cheek below need to be raised as well. In addition you can’t just raise the eye and adjust the bone around it without factoring in adjusting the upper and lower eyelids as well. (if you move the position of the window the overlying shade must similarly be adjusted or the window will look unusual/distorted)
While this sounds like a major undertaking, and it is, but this is the normal collection of procedures that are needed in significant VOD surgery. This is not a dangerous procedure, it is more a question of the magnitude of the asymmetry that can be achieved. It would take looking at the scan to provide a more qualified opinion in that regard.
Dr. Barry Eppley