Orbital Implant Surgery with Costal Cartilage Graft Is Associated with Better Symmetry and Improved Cosmetic Appearance

<b>Background/Objectives</b>: In Japan, artificial orbital implants are not approved as medical materials, limiting the number of facilities that perform orbital implant surgery. However, this procedure is crucial for improving the quality of life of ocular prosthesis users by enhancing cosmetic outcomes. This study aimed to evaluate the short-term outcomes of orbital implant surgery using costal cartilage grafts and assess the cosmetic impact by comparing upper eyelid positions between patients who underwent the procedure and those who did not. <b>Methods</b>: Patients were divided into two groups: those who underwent evisceration and orbital implant grafting with costal cartilage (Group 1) and those who used a prosthetic eye without an orbital implant (Group 2). In Group 1 cases, following evisceration, a spherical implant was created using the sixth autologous costal cartilage and covered with four pedicled scleral flaps. The incidence of complications and the necessity for additional surgery were investigated through medical records, and both complications and upper eyelid symmetry were assessed at least 12 months after the final surgical procedure. <b>Results</b>: A total of 23 patients were included: 13 in Group 1 and 10 in Group 2. Group 1 had a significantly lower median age (52 vs. 68 years, <i>p</i> = 0.002) and a higher proportion of females (76.9% vs. 30%, <i>p</i> = 0.024). Upper eyelid asymmetry was significantly greater in Group 2 than in Group 1 (<i>p</i> < 0.05). Orbital fracture was associated with a higher risk of requiring additional surgery (100% vs. 37.5%, <i>p</i> = 0.075), though not statistically significant. <b>Conclusions</b>: Orbital implant surgery with costal cartilage grafts improves eyelid symmetry and cosmetic appearance. Early and accurate orbital volume repair is essential for preventing enophthalmos.