Is It Possible to Achieve a More Deep-set Eyes?

Question

I am half-Asian with large eyes, thick eye creases. An Asian Eyelid surgery wouldn't really make sense for me since I already have very thick caucasian creases.Oddly, my eyes are pretty shallow-set, in fact, they bulge out a bit. This makes my profile look very weird. I think that if my eyes were deeper set into the head..it would look much better. It sounds like a drastic and scary operation though. Any idea if it can be done and how? Thanks!

Kenneth D. Steinsapir, MD · Answer

Dear Smilebaby
This is an unusual concern that you are describing. It is the nature of the world we live in that you may find someone who will try to do whatever you ask. However, you need to be carefully assessed to determine if what you are considering makes sense. Orbital decompression with fat and bone remove is used to set the eyes back into the orbit when thyroid eye disease pushes the eyes forward. However, it is much less common to use these surgeries to perform "comsetic' orbital decompressions for the purpose of moving the eyes back.
My best advise is to seek several opinions for expert ophthalmic plastic surgeons.  These are board certified ophthalmologists with specialized training in eyelid and orbital plastic surgery. 
The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a directory that will help you located a quailified doctor near where you live: www.ASOPRS.org.

Richard J. Bruneteau, MD · Answer

When patients are noted to have prominent eyes, they should be evaluated for both congenital and medical conditions. Medical conditions such as hyperthyroidism can cause prominent globes, while congenital conditions can cause the boney orbits to be small. Both conditions can make the eyes protrude in an outward direction.The vast majority of patients with slight eye prominence fall into normal range. The vast majority of these patients aren't bothered by the appearance of their eyes.Rarely, patients request treatment of this condition. Under these circumstances, it's possible to make the eyes more deep set by performing an operation known as an orbital decompression procedure. Unfortunately, this procedure is complicated and has a poor risk benefit ratio and for this reason, is only rarely utilized unless severe deformities are present.When patients are concerned about prominent eyes, it's important that they be evaluated by a board certified plastic surgeon. This surgeon should be able to formulate a treatment plan that addresses their anatomic findings and aesthetic goals.

David C. Pearson, MD · Answer

Orbital decompression is the name of the procedure done to achieve what you're describing. But it's an operation reserved for significant eye problems from diseases such as Graves' ophthalmopathy. A frequent side-effect of such decompression surgery is diplopia--double vision--which has to be subsequently corrected by additional surgery on the eye muscles.
From a cosmetic standpoint, the risks don't justify the procedure.
All the best,
--DCP

William Portuese, MD · Answer

The eyeballs cannot be made more deep-set into the orbit of the face. Fat pads when present on the lower lids can make the area look puffy, these can be removed to create the illusion of a more inset eyelid. However, the puffiness has to be present first prior to removing any of that lower orbital fat.

Kenneth R. Francis, MD, FACS · Answer

Smilebaby,
Bulging eyes or exophthalmos can be caused by metabolic/endocrine conditions such as hyperthyroidism.  Start with a visit to your internist for some simple blood tests to rule out these conditions.  Then, you might want to see a board certified plastic surgeon for options to correct your eye appearance.  Good luck!

Steven Wallach, MD · Answer

Trying to make the eyes deeper set in the orbital cavity is usually not done for patients unless they have sever exopthalmos. When this is performed, usually out fracturing is performed to make the cavity larger to accomodate the eye.

Peter A. Aldea, MD · Answer

As we age, we lose fat volume in our orbits and our eyeballs naturally sink in. The same happens if FOR ANY REASON the volume of the eye socket is made larger (such as a fracture of the floor of the orbit, removal of part of the side wall of the socket (as is sometimes done in hyperthyroidism where the periorbital fat increases in volume due to inflammation).
It is really NOT complicated to cause the eyeballs to fall more into the socket. The question is how much floor or side wall widening needs to be done ? and Is it worth it? Uniformly, the long term result will be poor. It will prematurely age you.
Personally, I do not feel such an operation is an ethical operation in your case NOR would I want to be associated with such a result.

Richard P. Rand, MD, FACS (retired) · Answer

What you are describing can be done for certain extreme conditions like hyperthyroidism but for purely cosmetic purposes, this would not be safe to try.

Is It Possible to Achieve a More Deep-set Eyes?

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