I’m so lost on this bulging eyes situation

[Oesteogenesis]

I’ve been told by a lot of people I have bulging eyes so I went to the ophthalmologist and they legit told me nah I don’t, then I look back at my pictures it’s so clear it’s bulging like its genuinely confusing. Can someone help man. I can’t tell if it’s recessed infras cheekbones, knowing my luck probably everything and it’s pissing me off. It causes me a condition called lagophthalmos which means my eyes literally never fully close because my eyelids don’t meet, I’ll have to get surgery this summer likely or next year to fix this issue. But guess what since I have this stupid recessed face and a negative orbital vector I can do anything because it would likely cause pressure/tension if the eyelid is raised and thus it would relapse and I’d look like a bug eyed freak again . (I’ve made too many threads on this wow this sucks)

Tldr:
no clue if I have bulging eyes, is it caused by recession of some areas e.g zygos, infras etc…

This issue is causing me to have medical issues where my eyelids don’t meet (lagophthalmos)

Surgery is needed and it’s likely I will have to decide on one in a few weeks also it’s funded by the gov but any eyelid retraction surgeries would relapse since I have a negative vector. Please help.

Spoiler: Side looking down and up

Spoiler: Front looking forward and down variations

Im so confused as why my side profiles orbital vector gets better once I look down and also You can see the eye ball bulging at the top. Ofc the obvious scleral show and bug eyes appearance, luckily I look okay normally since I perma squint but it’s still bad.

Yes my nasal projection is bad and so is my browridge and those are factors I’m including too, I still don’t understand why that line appears under my eyes when I look up though or if that’s even related to anything.


Some medical stats:

Hertel measurement : 18mm
Thyroid function: tsh 2.53 and t4 18.4 (I don’t agree on why the gp tested me for only 2 hormones and not even the antibodies)
BF: 20% (likely to hide some features and areas)


I’ve gotten help a lot from multiple people here, and they have been very helpful and I’m grateful but I’m still so lost because I don’t understand what the actual root problem is. It’s just been mixed opinions and now theres solutions which I can’t take because it would likely relapse and return to normal, I’ve made a shit ton of threads like this now and even on my last one said that one would be the last but man I’m so lost idk what to do.

its so unlucky because my condition can be caused by bulging eyes (lagophthalmos) so i got a hertel measurement and its apparently within the normal range (still prominent ofc lol, 2-3mms off getting orbital decompression), idk if im
Schizo aswell but I legit see the eye bulging out at the top when I look down too. Might request an mri or a ct next time I go.

Any sort of advice is appreciated, thank you.

tags): @Nahorscend @BronzeSpartan2 @bossman @vermicel @thecel

 

[Dizzle]

yeah you have bulging eyes now mark me as solution

 

[Oesteogenesis]

yeah you have bulging eyes now mark me as solution

Folk

 

[academicmaxxer]

solved by 1.. brow ridge implants. 2. infraorbital implants. also you have scleral show. you also need under eye fat grafts.

orbital decompression isnt necessary.

 

[Yahya]

solved by 1.. brow ridge implants. 2. infraorbital implants. also you have scleral show. you also need under eye fat grafts.

orbital decompression isnt necessary.

is orbital decompression obo or is it different ?

 

[academicmaxxer]

totally different surgeries

 

[vermicel]

@Oesteogenesis have you consulted Douglas & Ramesh ? If not, that's probably the best thing you can do at this point in time, instead of expecting a definite answer from .org autists.

 

[Oesteogenesis]

@Oesteogenesis have you consulted Douglas & Ramesh ? If not, that's probably the best thing you can do at this point in time, instead of expecting a definite answer from .org autists.

I think I’ll give them a ring now, I’ve tried to book one with Daniel Erza but dudes next appointment is at the end of October. I’ll also try maybe contact Ramesh on Reddit too pretty sure he’s active rn

 

[vermicel]

I’ll give them a ring now

Orbital Decompression New Jersey | Center For Eye & Facial Plastic Surgery

Dr. Ramesh has performed hundreds of orbital decompressions and is one of the most experienced surgeons in the United States for this procedure.

www.centerfacialplastics.com

[email protected]

Frequently Asked Questions | Raymond Douglas

Meet Dr. Raymond Douglas, an expert oculoplastic surgeon, on his FAQ page. Get answers about innovative treatments and procedures.

raymonddouglasmd.com

[email protected]


I assume you can schedule a virtual consultation within weeks after initiating contact. Definitely earlier than October anyway

 

[Oesteogenesis]

Orbital Decompression New Jersey | Center For Eye & Facial Plastic Surgery

Dr. Ramesh has performed hundreds of orbital decompressions and is one of the most experienced surgeons in the United States for this procedure.

www.centerfacialplastics.com

View attachment 4805081
[email protected]

Frequently Asked Questions | Raymond Douglas

Meet Dr. Raymond Douglas, an expert oculoplastic surgeon, on his FAQ page. Get answers about innovative treatments and procedures.

raymonddouglasmd.com

View attachment 4805096
[email protected]


I assume you can schedule a virtual consultation within weeks after initiating contact. Definitely earlier than October anyway

Thank you , I’m sending off the emails right now. I think I’ll need to contact them via phone aswell since I’m an international patient.

 

[bossman]

I disagree with previous posts and don't think consulting Ramesh and Douglas is going to help much

In terms of aesthetics, every case such as yours comes down to some combination of bulging eyes, congenital negative vector morphology, and eyelid sag. Hence, someone like Ramesh or Taban would suggest a combination of canthoplasty with spacer graft, infraorbital implants and orbital decompression.

In my opinion, the difference the eyes being too forward and the infraorbital rim being too recessed is not clear cut. So one doc might suggest OD for you, and another might suggest infraorbital implants, and another might suggest both. And nobody is necessarily wrong or right.

The only cases in which you can definitively say the eyes are too forward are in cases of very high Hertel measurements (21mm+), or actual thyroid issues which are documented to cause proptosis. At 18mm you are well within normal range, making most OD surgeons cautious to perform OD on you.

From your initial post, it seemed like the functional issues bothered you the most. If Prof. Ezra is convinced a canthoplasty can resolve it, I'd trust him and go with that. You can get implants later. I would not recommend you to consider OD unless you have the money and are aiming for the perfect aesthetic result and are willing to sacrifice a lot of time.

If you still feel compelled that OD might be a suitable option for you, consult Ramesh. Don't bother with Douglas - he's the best but is triple the price. You need a CT scan so he can evaluate properly.

I guess maybe you can be suspicious about whether the Hertel measurement is accurate, and try to verify it by having someone else measure it, or getting a CT scan and measuring it on there, or doing the credit card method I linked to earlier.

 

[Oesteogenesis]

I disagree with previous posts and don't think consulting Ramesh and Douglas is going to help much

In terms of aesthetics, every case such as yours comes down to some combination of bulging eyes, congenital negative vector morphology, and eyelid sag. Hence, someone like Ramesh or Taban would suggest a combination of canthoplasty with spacer graft, infraorbital implants and orbital decompression.

In my opinion, the difference the eyes being too forward and the infraorbital rim being too recessed is not clear cut. So one doc might suggest OD for you, and another might suggest infraorbital implants, and another might suggest both. And nobody is necessarily wrong or right.

Pretty tough spot for me ngl, it kinda sucks because its not just one fix aswell and im basically in the middle of this shit show so the solutions are limited through the NHS, ofc privately this would be much more clear but i am young and broke so that wont be for a while (except for cantho, just saying more expensive surgeries like OD and Implants are way out of my range).

The only cases in which you can definitively say the eyes are too forward are in cases of very high Hertel measurements (21mm+), or actual thyroid issues which are documented to cause proptosis. At 18mm you are well within normal range, making most OD surgeons cautious to perform OD on you.

Yea i mean when i was getting my measurement i didnt really feel it on the socket im assuming the lateral socket, im not sure if you are but i read on reddit you would get that feeling and asked ai too. Ill try again and ask them for a CT or MRI just to make sure.

From your initial post, it seemed like the functional issues bothered you the most. If Prof. Ezra is convinced a canthoplasty can resolve it, I'd trust him and go with that. You can get implants later. I would not recommend you to consider OD unless you have the money and are aiming for the perfect aesthetic result and are willing to sacrifice a lot of time.

TBH im not sure if he was convinced the email was from his secretary stating : "Daniel Erza has reviewed your photos and believes there is a strong possibility that we can assist you" so its not confirmed that a canthoplasty alone can help, however its likely it wont because as i stated before, the pressure/tension created by the lack of structure.

I also asked her on the phone (the secretary) about the negative orbital vector issue, and she did warn that she wasn't qualified and didn't have much knowledge, however said there could be a possibility of some sort of graft being used to add structure and lift the eyelid up, and the final price she said on average for that was £12,200 which is a fuck ton ngl, legit more double the canthoplasty cost at £6050.

I mean this surgery would 100% be funded by the NHS now, as they said in my last appointment and so did my optician aswell, it just likely ends with some sort of surgery. So going with Daniel erza and hopefully requesting the NHS for some sort of graft could work out but this outcome is still possible since the only other surgery options ive seen publicly within the NHS are: tarsorrhaphy, Implanted Weights into the upper eyelid and Canthoplasty (unsure but maybe a spacer graft of some sort aswell).

If you still feel compelled that OD might be a suitable option for you, consult Ramesh. Don't bother with Douglas - he's the best but is triple the price. You need a CT scan so he can evaluate properly.

I guess maybe you can be suspicious about whether the Hertel measurement is accurate, and try to verify it by having someone else measure it, or getting a CT scan and measuring it on there, or doing the credit card method I linked to earlier.

Yea i mean my main concern is that even if any eyelid surgery is done, as @Nahorscend said to me too, is that the pressure/tension created by the procedure could lead to a relapse since there's no structure (negative orbital vector) to keep it stable. Ive already emailed Ramesh and Douglas and ill see what he replies with but i should probably try get a CT scan just so i can make sure the Hertel is accurate and also for the consultations if they request it. Their opinion is all i need ngl, since either way i cant get OD for now even if i wanted to.

Thanks for the help though, hopefully all of this will be over by the end of this year. One can only pray that it will be . Either way i think OD would still be an option is the future since 18mm is still considered prominent but i mean i hope i dont need it, ill probably get some sort of implant (infra-malar) first before i consider it.

 

[Oesteogenesis]

Orbital Decompression New Jersey | Center For Eye & Facial Plastic Surgery

Dr. Ramesh has performed hundreds of orbital decompressions and is one of the most experienced surgeons in the United States for this procedure.

www.centerfacialplastics.com

View attachment 4805081
[email protected]

Frequently Asked Questions | Raymond Douglas

Meet Dr. Raymond Douglas, an expert oculoplastic surgeon, on his FAQ page. Get answers about innovative treatments and procedures.

raymonddouglasmd.com

View attachment 4805096
[email protected]


I assume you can schedule a virtual consultation within weeks after initiating contact. Definitely earlier than October anyway

Got a reply back and man that price is fucking brutal, safe to say I won’t be able to afford it for a while. Unfortunate but oh well, time to wage slave or pray something works out, idk kinda lost hope but yea.