In today's world, it seems as though there is a plastic surgery or cosmetic procedure that will treat just about every type of facial flaw. However, this is not necessarily true. Plastic surgery procedures are frequently performed to augment or remove the skin and tissues within the body (such as with breast augmentation or liposuction). In some cases, plastic surgery procedures may involve the removal and reshaping of bone material (such as with rhinoplasty or chin reduction surgery). There are certainly fewer plastic surgery procedures that involve bone reshaping, as this approach is far more invasive and associated with an increased risk of complications. So, in cases in which bone removal is required to reduce the appearance of a prominent facial or body feature, the patient's options are far more limited.
When it comes to truly deep-set eyes, bone removal would be required to reshape the underlying bone structure that produces this appearance. Theoretically, the glabella, zygomatic bone, and supraorbital ridge would need to be shaved down to bring the eyes forward and eliminate the deep set appearance. Since this type of elective surgery is dangerous and the benefit-to-risk ratio is poor, it is rarely performed.
In a few cases, the eyes may appear to be deep-set because of excess skin or fat on the forehead, upper eyelids, or lower eyelids. In these cases, the following fat removal and skin tightening surgeries may be performed:
Browlift: If the eyebrows have descended, resulting in a perpetually angry or sad appearance, browlift surgery can be performed to lift the sagging skin, remove excess skin, and tighten the underlying forehead muscles. During this surgery, excess fat, if present, can also be removed or dispersed to produce a smooth and attractive appearance.
Upper eyelid surgery: Upper eyelid surgery is indicated when excess fat accumulates in the upper eyelids or the eyelid skin becomes so lax that it hangs down. In cases of severe skin looseness, the hanging skin may even obstruct the patient's vision (in these cases, health insurance may fully or partial cover the cost of surgery). During eyelid surgery, incisions are made in the upper eyelid crease; fat is evenly distributed or removed and the skin is tightened.
Lower eyelid surgery: Ideal candidates for eyelid surgery have an excess of fat in the pockets just under the eyes. This can make under eye circles more prominent and contribute to an aging appearance. Lower eyelid surgery can be performed to remove extra fat and skin on the lower lids.
Another treatment that is often performed to reduce a gaunt or hollowed out appearance to the eyes is the use of dermal fillers or fat transfer injections under the eyes. If a gaunt appearance is making your eyes look like they are set back too far in the face, injections may be used to add more volume to the area. However, for some patients, this may make the eyes look even more deep-set.
The only way to find out which of these treatments, if any, are right for you is to contact a reputable plastic surgeon in your area.
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