Is Orbital Decompression for Asymmetry of the Globes Possible?

I have one buldgy (L)eye, likely d/t poor maxillary support and congenital anomaly. One surgeon recommended malar implant, but indicated it may only improve symmetry slightly. Another suggests autologus fat transfer to cheek, which is essentially the same(?). Could I simply get a unilateral decompression instead? No thyroid eye disease indicated from hormone tests and MRI though. Or perhaps an ocular implant? My eyes were normal just 4 months ago. So there must be space there?

Doctor Answers 3

Orbital Asymmetry Correction

The first place to start is to get an assessment of the orbital and facial bony anatomy by getting a 3-D CT scan. That will show the differences in the orbital shapes and floor and determine if dropping the eye on the normal size or trying to elevate the eye on the affected side is better. As a general rule, it is usually best to not disrupt normal anatomy when trying to achieve symmetry in facial differences. Unless the CT scan shows otherwise, I would recommend trying to achieve globe and eyelid elevation and malar augmentation on the abnormal side. A realistic goal is improvement in the asymmetry but not perfection.

Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Tomography is indicated in your case for unilateral prominent eye

I do not understand the two photos above.  Are you asymmetrical on the left   photograph and post operative on the right?  Your left eye is lower on the left photograph.  This could be improved with craniofacial surgery and bone grafting.  Visit your local medical center and childrens hospital to find such a surgeon.

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon
5.0 out of 5 stars 1 review

Unilateral Decompression for Asymmetry

You certainly could do that and the result would be a good one though it is difficult to say exactly how you would look or if the symmetry would be perfect.  As you are a Black gentleman I would suggest a trans-conjunctival approach so there are no external incisions; they would take some time to heal and become seamless. 

A malar implant would be a good option but again, symmetry can't be totally assured.

More photos are needed for better advice but I will say you should explore your orbital disease and proptosis very thoroughly before proceeding with surgery.

Best of luck.

Dr. Chase Lay

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

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