One eye is set back farther than the other. This has bothered me my whole life. How is the procedure done? (Photo)

Question

I am thinking about scheduling consults with an occuloplastic surgeon. However, I’m curious about what the surgery entails (I would want the “smaller one eye”set further forward to match my right eye. How is the procedure done and how risky is it? I understand all surgery has risks but want the community opinion on if this would be worth it. Thank you so much.

A.J. Amadi, MD · Answer

Its a coincidence that you post this question now as I just had a patient visit me from NYC for consultation for this exact problem. An orbital implant is used, usually on the floor of the orbit, but sometimes either laterally or medially to shrink the size of the bony socket and push the eye forward. I like to use medpor usually as it better integrates, but have used silicone/nylon as well. Risks included double vision (mostly likely risk, but still very low), infection, and incredibly rarely vision loss due to bleeding. Its a very common technique that I use for facial fractures, but would be done for a cosmetic reason. Definitely consult with an Oculofacial Plastics Surgeon (Oculoplastics) as this is a common surgery for us. Best regards and good luck!

Stephen J. Pincus, MD · Answer

I am not an oculoplastic surgeon, but have referred patients with "enophthalmos" to them. Obviously, they will do the necessary testing to determine the appropriate anatomy re both eyes. If they come to the conclusion that one eye is normal and the other set back too far, a wedge (silastic?) is placed on the floor of the setback eye to cause it to be positioned more anteriorly. This is my fairly simplistic impression of what they told me is done. You are right in seeking several oculoplastic surgeons' opinions before proceeding.

Mats Hagstrom, MD (license on probation) · Answer

I think you purposely took your pictures to accentuate the problem.
My best guess is that in a neutral position or in most pictures the problem is not nearly as evident.
there are two issues going on. One is that you have natural asymmetry of your facial skeleton with one eye socket sitting further forward than the other.
The second situation is that one eyesocket maybe smaller or the eyeball itself may be different size.
Correcting the first problem is highly invasive and should not be done. Correcting the second problem is done by manipulating the volume of the eyesocket.
I don’t think anybody else perceives your asymmetry as being nearly as much of an issue as you do when you look in the mirror.
My best guess is most people don’t notice it.
Everyone has facial asymmetry. There has never been a human being born with a symmetrical face.
Our brain is accustomed to seeing asymmetry as part of appropriate and natural facial beauty.
Sometimes we offer surgery only because a situation bothers an individual. Sometimes the individual feels the rest of the world perceives them as being different or less desirable.
Personally I would encourage you to accept your unique asymmetry as being more on the spectrum of normal but the amount of eyeball show or proptosis can be corrected by manipulating the eyesocket volume.
Personally I think your Right eye looks better. Decreasing the socket volume on the left would make both eyes look more like the one on the right.
It’s possible to fracture the bone and open the eyesocket causing the eyeball to come in (look smaller)  but this is a little more involved.
Do you really wanna go through this?
This is definitely something that warrants in person consultations.
my recommendation is seeking expert opinion from senior providers who have been around the block enough times to know when to not operate.
Just because someone can do an operation doesn’t necessarily mean they should do an operation.
Best, 
Mats Hagstrom MD

One eye is set back farther than the other. This has bothered me my whole life. How is the procedure done? (Photo)

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One eye is set back farther than the other. This has bothered me my whole life. How is the procedure done? (Photo)

Answers (3)

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