The shape of the eye is affected by its numerous hard and soft tissue anatomic components. The bony orbit is one of the eye’s major influences on its shape as it provides a circumferential rim of support onto which all surrounding soft tissues are attached either directly or indirectly.
While there is no standard bony orbital shape that is most aesthetically acceptable, in general it has an oblong shape that corresponds to eyelids that are horizontally longer than they are high. The slope of the brow area, particularly at the lateral or temporal area, influences the oblong shape of the eye as well as its supratarsal fullness. A low temporal supraorbital rim can not only produce a visible bony bulge at the northwest corner of the eye but also make the upper eyelid look full or puffy.
A 3D CT scan can confirm a more unaesthetic supraorbital rim slope that may benefit by inferior reduction…which can help make the eye more open. By raising the level of the inferior edge of this portion of the brow bone the eye may look more open and some of the lateral supratarsal fullness reduced.
Vertical reduction of the lateral brow bone is one of the most uncommon of all brow bone reduction techniques. This is partly of a result of it being unappreciated for its influence on aesthetic eye shape. It is performed through an upper eyelid incision and can be done as part of an otherwise blepharoplasty that is being performed (full eyelid incisions) or can be done in isolation through a hemilid or partial eyelid incision. The superolateral brow bone is vertically reduced through a combination of rongeurs and a high speed rotating burr. The bony corner can be elevated by at least 5mms in a 9 to 12 location for the right eye and a 12 to 3 location of the left eye. It is difficult to reduce the brow bone past the supraorbital nerve/notch.
While eye-opening surgery often involves the eyelids bony changes of the orbital rims can also have an effect. This is manifest in the lateral or temporal brow bone which permits a significant reshaping effort.
Dr. Barry Eppley