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M. Reza Vagefi, MD; Tristan F. W. McMullan, PhD, MRCOphth; John R. Burroughs, MD; George L. White Jr, PhD, MSPH; John D. McCann, MD, PhD; Richard L. Anderson, MD

Arch Facial Plast Surg. 2007;9(6):439-442.

Objective  To describe a new method of augmenting orbital volume for anophthalmic enophthalmos correction.

Methods  A retrospective medical record review was conducted of 4 consecutive patients who had injectable calcium hydroxylapatite (Radiesse) placed in the extraconal space to augment orbital volume.

Results  Four patients were treated with 1 to 2 vials (1.3 mL per vial) of injectable calcium hydroxylapatite. The mean amount of preoperative enophthalmos measured by Hertel exophthalmometry was 4 mm (range, 2-7 mm). The mean follow-up was 57 weeks (range, 45-71 weeks). A reduction of enophthalmos, ranging from 2 to 5 mm (mean, 2.75 mm), was observed when comparing preoperative with postoperative measurements of the anophthalmic orbit with prosthesis in place. All patients demonstrated clinical and aesthetic improvement that was observed to continue at almost 1 year or more postoperatively. In one patient, injection was complicated by a peribulbar hemorrhage related to local anesthesia administration, which resolved without incident.

Conclusions  Injectable calcium hydroxylapatite provides a new, safe, simple, cost-effective technique to treat volume deficiency in the anophthalmic orbit. Augmentation achieved with this semipermanent filler has demonstrated a lasting effect in the orbit of 1 year or more with little volume loss. The filler seems to last longer in areas with less movement, blood supply, and lymphatic drainage. Injection can even be performed in an office setting using local anesthesia. The amount of volume replacement can be titrated, and the procedure is repeatable until adequate volume is obtained.

Author Affiliations: Center for Facial Appearances, Salt Lake City, Utah (Drs Vagefi, McMullan, McCann, and Anderson); Eye and Facial Appearances, Colorado Springs, Colorado (Dr Burroughs); and Department of Family and Preventative Medicine–Public Health, University of Utah, Salt Lake City (Dr White).