What is the correct approach for prominent / protrusive eyes? (OD vs infra support vs eyelids) (Photos)

Question

I’m trying to understand what is actually causing the appearance of my eyes, as I’ve received mixed opinions. My concerns are: prominent / protrusive eyes, under-eye area looking unsupported / baggy, high amount of eyelid show, and an overall droopy / unbalanced look. I’ve had suggestions including: orbital decompression, ptosis repair, lower eyelid retraction / canthoplasty, and infraorbital support. My main questions are: 1. Does this look more like true globe prominence (OD), or more of a support / eyelid issue? 2. Could eyelid surgery and/or infraorbital support alone improve this, or risk worsening it without addressing prominence first? My goal is a less prominent, more supported, balanced eye appearance Thank you

Kadir Berat Oyur, MD · Answer

The concerns you are raising regarding globe prominence versus a lack of infraorbital support are very insightful, and in your case, it appears to be a combination of both rather than one isolated issue. Based on your photos and the CT scans, there is a degree of true globe prominence (morphologically known as a "negative vector" relationship), where the eye sits forward relative to the cheekbone; however, this is significantly exaggerated by the lack of structural volume in the infraorbital rim and tear trough area. If you were to pursue eyelid surgery or ptosis repair alone without addressing the foundation, you would risk further "skeletonizing" the eye or worsening the retraction, as the soft tissue still wouldn't have a stable shelf to rest upon. A more balanced, long-term approach typically involves using infraorbital implants or custom malar implants to build up that recessed bone structure first, which provides the necessary support for the lower lids and naturally creates a more recessed, harmonious, and "supported" appearance for the eyes without the high risks associated with more invasive orbital decompression.

What is the correct approach for prominent / protrusive eyes? (OD vs infra support vs eyelids) (Photos)

Answers (1)

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