Orbital hypertelorism is a complex craniofacial anomaly extending beyond wide-set eyes, involving abnormalities of the orbits, nasal framework, soft tissues, and midface. Despite advances in craniofacial surgery, achieving consistent aesthetic harmony remains challenging due to the interdependence of skeletal and soft-tissue components.

This study presents the cumulative clinical experience of a single tertiary craniofacial centre and highlights key aesthetic considerations, emphasizing a component-based approach to achieving optimal facial balance in orbital hypertelorism correction.

A retrospective single-centre descriptive clinical study of 66 patients with orbital hypertelorism treated between 2006 and 2024 at a tertiary craniofacial centre was performed. Demographics, associated anomalies, surgical techniques, aesthetic outcomes, complications, and follow-up were analysed. Ethical approval and informed consent were obtained.

The mean age at surgery was 11.2 years, with a mean follow-up duration of 4.8 years (range 1–10 years). Cleft-related hypertelorism was present in 43 patients (65.2%), craniosynostosis in 18 (27.3%), and other nasal pathologies in 5 (7.6%). Box osteotomy was performed in 58 patients (87.9%), facial bipartition in 6 (9.1%), and spectacle osteotomy in 2 (3.0%). Intercanthal distance was reduced by 10–15 mm, and all patients with vertical orbital dystopia achieved complete correction. Orbital vector and globe projection were clinically preserved throughout follow-up. Combined hypertelorism correction and primary rhinoplasty improved nasal aesthetics, while midline soft tissue excision achieved effective correction of epicanthal folds. Improvement or resolution of strabismus was observed in the majority of affected patients following orbital repositioning alone. CSF rhinorrhoea occurred in 8 patients (12.1%) and resolved conservatively; one patient required revision surgery.

A component-based surgical approach integrating orbital repositioning with simultaneous nasal, soft-tissue, and midfacial correction provides reliable aesthetic improvement and can achieve stable long-term outcomes in appropriately selected patients.