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Case History
When the patient in this case study first presented in 2008,
he was 61 years old. The initial interview with the patient
yielded few details about his history as the wearer of a
prosthetic eye. He stated that his eye had been removed
(it appeared that his eye had been enucleated) when he
was very young and that the reason for the removal was
“some type of birth defect.” He believed that the prosthesis
he was wearing was approximately 29 years old. He had
no idea who had made it nor where it had been made. His
major complaints were that it was too small; it rotated; and
it was cosmetically unacceptable.
The patient was impression-fit for a new prosthesis in
October of 2008 . That new prosthesis was completed and
delivered with satisfactory results (Figure 1). At that time,
the patient was advised to return in 30 days for a follow-up
visit and it was recommended that he return bi-annually
for regular professional cleaning of his ocular prosthesis.
Despite having scheduled a 30-day follow up appointment
and being recommended for bi-annual cleanings, the
patient did not return to our office for ten years. When he
did return in 2018, he indicated that the 2008 prosthesis Figure 1. Patient wearing new ocular
no longer fit properly and that it “did not look right” prosthesis that was fit in 2008.
(Figure 2).
Discussion
Many factors affect a change in the appearance and
structures of the face as one ages. Doctors Sydney
Coleman and Rajiv Grover, writing in the Aesthetic Surgery
Journal, make the following observations: “Aging of the
human face is the result of both superficial textural wrin-
kling of the skin and changes in the three-dimensional
(3-D) topography of the underlying structures”…“The
major forces contributing to facial aging include gravity,
skeletal remodeling, subcutaneous fat redistribution and
loss, hormonal imbalance, chronic solar exposure, and
smoking. Other environmental factors that are purport-
ed to affect facial appearance include mental stress, diet,
work habits, drug abuse, and disease.” 2
Dr. Jordan P. Farkas—OR of the Department of Plas-
tic Surgery at the University of Texas Southwest Medical
Center in Dallas, Texas—co-authored the article titled “The
Science and Theory behind Facial Aging,” in which he cites
various studies that support a theory of “deflation.” The
authors of this article make the following observations:
“…deflation and loss of the normal anatomic subcutane-
ous facial fat compartments gives off the appearance
of increased skin laxity or prominent folds around the Figure 2. Ten years later the 2008
nasolabial region, periorbital region and jowl.” 1 ocular prosthesis no longer fits well.

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