How Prominent Eyes and Negative Vector can be Improved without Risky Eye Decompression Surgeries

By: Amiya Prasad, M.D.

Thank you for your question. You submitted your question with a photo and you hate your prominent eyes and you’ve been reading about a procedure called orbital decompression. And you state that you have minus ten myopia. And finally you ask, what can be done to improve the appearance of your eyes. Well, I can certainly share with you my perspective on your question and certainly, how I have this type of discussion in my practice. A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. And certainly, I have plenty of experience when it comes to orbital decompression as the most common indication for a condition called thyroid eye disease or thyroid related immune orbitopathy.

And I think that there’s an opportunity here to appreciate some of the perspectives that one can have when looking at your face and your eyes. And what do I mean by that? Well, to begin with, let’s start with understanding how your eyes relate to the eye socket alone. When someone has minus 10 myopia, well that’s considered as high myopia and that means that the shape of the eyeball is longer. And when the shape is longer, as opposed to like a smaller egg shape, well it does have some contribution to the relative prominence of the eye. And sometimes patients who will come in and I’ll ask about their thyroid and if they have a history of thyroid eye disease, they’ll tell me, “No, I don’t. Everyone thinks I do.” It’s either prominent eyes that are a family characteristic or it also happens to be that they have high myopia and their eyes are a little bit more prominent.

Now that being said, one other perspective to look at is the relative projection of your cheekbone. So if the eye looking relatively prominent relative to the cheekbone, well if you just draw a line straight from the cornea downward and the cheekbone is behind, well we often refer to that as a negative vector and that comes into play when we discuss about lower eyelid blepharoplasty. So what I think is also worthwhile considering is some way to actually enhance the projection of the cheek. Now of course, as a surgeon or as many surgeons do when we think of surgical solutions but we live in a time where we have a lot of non-surgical options. And so my first thought would be is to not do a procedure like orbital decompression. Although it has been done for patients with high myopia and certainly it can work, within the concept of orbital decompression is typically, because you don't have excess volume or fat or muscle thickness as is the case in thyroid eye disease, you may be are looking to what’s called a bony decompression and with that comes a lot of certain significant risks. When I look at someone like you and of course having also a facial cosmetic surgery background, I look at the face as a whole and the eyelid and the cheek area, so I would actually have you consider something like Structural Volumizing as a non-surgical approach. That means using a long lasting filler that’s placed in the bone level.

By doing this type of Structural Volumizing, you can actually enhance and since you’re a younger person, we don't refer to this as restoration but rather with some degree of enhancement or augmentation. You can enhance the volume of the cheek as it relates to the eye itself and you may find yourself benefiting from a little bit more balance. When people don’t like something about their face, very often, it’s just a subtle amount of shifting of proportion that can create more of what is considered as aesthetically pleasing.

How Prominent Eyes and Negative Vector can be Improved without Risky Eye Decompression Surgeries

So I think that it is my style to first try something less invasive before doing something more aggressive. I would also caution you that when you have high myopia, you are at high risk for retinal detachment. And although there isn't necessarily a cause and effect with having manipulation of the eye or surgical procedure around the eye and retinal detachment, that would also be my concern because the person with high myopia has the retina stretched. So relatively speaking, there are areas where it can be particularly thin and the risk of detachment and that’s why people with high myopia see retinal specialists regularly. That being said, I think that when you think about doing something like Structural Volumizing injectable in the cheek area, well, that’s leaving your eye alone. So I think it’s worth considering and it’s what I would just start with before you consider other procedures whether it’s a submalar implant or infraorbital rim implant and other things that can also be an option. But I think that we live in a time where we have these really nice injectables that can provide significant time of lasting such as a Juvederm Voluma or Juvederm Ultra Plus that can last over a year and even longer. So learn about these options.

Find and meet cosmetic surgeons who have experience with this area. If you want to learn more about decompression, of course, you probably want to meet with an oculofacial plastic and reconstructive surgeon and just try to get a sense of where you want to go. So I hope that was helpful, I wish you the best of luck and thank you for your question.

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