What Type Of Orbital Box Osteotomy Is Needed for a 5mm Interpupillary Increase?

Q: Dr. Eppley, I’d like to inquire about procedures for improving narrowly spaced eyes. My narrowly spaced eyes have been a lifelong insecurity  and it increasingly negatively impacts my disposition. I understand that procedures to improve this trait are risky (orbital box osteotomy), but I am tremendously motivated. To put the extent of the trait into numbers, I have measured a few lengths:

intercanthal distance: 27.5 mm

interpupillary distance: 59.5 mm

bizygomatic width: 141mm

eye spacing ratio: 59.5mm/141mm = 0.421

My intercanthal distance alone is below the range considered normal in the population (>28mm), and is thus abnormal. Furthermore, having narrowly spaced eyes makes my face appear longer and thus more masculine, making it more difficult to live as my desired gender.To provide an actual goal in numbers, I’d like to aim for an ES ratio of 0.46 – 0.47. To achieve this, I’d like my interpupillary distance increased by 5mm.

A: You are referring to orbital box osteotomies as you have noted. This is not a ‘risky’ surgery medically, it is just a procedure where the ‘effort vs reward’ ratio is tilted a bit unfavorably. Meaning you have to do a big operation to make a small change. (5mms) The most effective orbital box osteotomy is a transcoronal approach using a frontal craniotomy for exposure with a 360 degree osteotomy…but that is a bit extreme for a 5mm interpupillary  change. The more appropriate technique is a modified subcranial 180 degree orbital osteotomy which has less aesthetic risk and can be done through a combined lower eyelid and intraoral incisional approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon