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Archive for the ‘cheek implant’ Category

Contemporary Cheek Enhancement – Malar and Submalar Zone Considerations

Sunday, March 21st, 2010

The cheek or the midface region plays an important role in facial appearance. As one of the five facial bony prominences (brow, nose, chin, and jaw angles are the others), it is actually the most complex. It lacks any sharp angles, is made up of several bones that intersect together and is surrounded by three distinctly different soft tissue regions. While everyone appreciates that a high and strong cheekbone is desireable, it is not easy to quantitate what that should look like unlike chin projection or jaw angle width which can be actually be measured.

Rather than some absolute number, the cheek region is better recognized for what it does for facial shape and width. As part of understanding cheek morphology, one should not forget how the soft tissue below it affects how the bone looks above. Known as the submalar (below the cheek) region, it is affected by the size and prominence of the buccal fat pad. This golf ball-sized fat collection can be surprisingly large and it helps make for a rounder and fuller cheek region appearance. If the buccal fat pad is very large, it can make this area protrude or be quite ‘cheeky’. If this and other facial areas are small or atrophic, the facial shape may assume a more gaunt appearance.

Therefore when assessing the cheek area, the consideration of both bone (malar) and buccal fat (submalar) areas should be done. Implant manufacturers have recently showed an appreciation for this concept by expanding traditional cheek implants to include either (malar and submalar) or both. (combined submalar shells) Combinations of malar and submalar changes can often make for a better cheek result than just a ‘simple cheek’ implant alone. In some cases, cheek bone enhancement and some submalar reduction (buccal fat removal) may produce better cheek highlights. In other cases, submalar augmentation or a combined malar-submalar augmentation may be aesthetically better.

The uniqueness of  each person’s face and their desired cosmetic outcome must be taken into consideration when planning changes in this area. Removal, or more accurately, reduction of the buccal fat pad (buccal lipectomy) is a surgically simple procedure but it’s decision to do so is more aesthetically complex. Through a very small incision inside the mouth opposite the maxillary first or second molars, the buccal fat pad can be gently teased out. When doing at the same time as some type of midfacial implant, it can be done through the same incision. How much one removes is a matter of judgment. As a general rule, it is not a good idea to try and remove all of it. Not only may that be undesireable in facial appearance in the long-term, but there are several buccal branches of the facial nerve which interlace with the multi-lobed buccal fat pad. They exist most commonly on the superficial (outer) aspect of the buccal lobe, away from the area of intraoral manipulation. For this reason, aggressive buccal lipectomies may inadvertently damage these branches. I have never observedfacial nerve injury from a buccal lipectomy procedure but this attests to a more conservative resection philosophy. In uncommon cases with a very full and ‘fat’ face, a more complete buccal lipectomy may be justified. Such an approach works well when ‘fat-reducing or facial thinning’ procedures are being done such as neck liposuction and/or chin or cheek implants.

Conversely, submalar augmentation rather than reduction may be needed to help fill out a thin or gaunt facial appearance. While initially developed for lifting sagging cheek tissues over ten years ago, the submalar implant is much more commonly used to add soft tissue fullness rather than a lifting effect. If the cheek prominence is adequate but the underlying submalar region is thin or ‘sucked inward’ (indented), than an isolated submalar implant may suffice. If the overall cheek (malar and submalar) is too flat or deficient, then a combined malar-submalar implant may be needed.

When considering cheek augmentation as part of an overall facial improvement plan, both the malar and submalar regions must be considered together. Between expanded submalar implant designs and buccal lipectomies,  a more comprehensive approach with satisfying surgical results is now available.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Cheek Augmentation (Implants)

Saturday, January 16th, 2010

The appearance of a well-defined cheekbone helps provide a sculpted and youthful look as it provides midfacial prominence and give the appearance of a thinner lower face. Flat cheekbones can make a large nose look larger and a receding chin smaller. The cheekbones are one of the three convex prominences that help define your face, highlighting the eyes and adding balance to your features.

Cheek augmentation (also known as malar augmentation or malar implants) is a surgical method to bring the cheeks into better balance with your other facial features.

  1. How do I know I am a good candidate for cheek augmentation?

People who benefit by cheek implants have smaller or flatter cheek bones naturally and/or have sagging of the cheek soft tissues due to normal aging. With aging can also come deflation, or loss of healthy fat which normally lies just under the cheek bones. This can give a gaunt look to one’s face.

A cheek implant can build out the flat cheek bone, provided a lifting effect to sagging cheek skin, and can partially fill out a sunken in look. Think of it as adding substance which may just make the cheekbone bigger or help hold up sagging or collapsed tissues.

That being said, whether anyone would benefit by a cheek implant is as much an  artistic feel as a facial feature that can be precisely defined. Unlike other facial implants, such as chins or jaw angles which can be measured and morphed with computer imaging, cheek implants defy such analytical evaluation as the area is not a clean profile or silhouette. This is an area that requires a good evaluation and discussion with your plastic surgeon using a mirror and finger technique.

2. What are cheek implants made of?

The vast majority of cheek implants are made of solid silicone rubber that is very flexible. While there are a few other materials of which they are made, they are not very popular. What material they are made of is not as important as two other critical issues; what styles and sizes are available and how easy are they to insert. This is where silicone rubber has a huge advantage over other materials.

One type or style of cheek implant is not right for everyone. The cheek bone shape and geometry and the soft tissue overlying them is different for each patient. Just like the obvious benefits of different sizes, style or shape of the implant needs to be individualized. That is why there are nearly a half-dozen different cheek implant styles. Only a silicone rubber material can offer this diversity of selection.

The flexibility of silicone rubber and the ability to have feathered edges allows it to be the easiest material to position on the bone without having an edge that can be felt or seen.

3. How is cheek augmentation surgery done?

There are two approachs to placing the implant, from inside the mouth and through the lower eyelid. By far, the intraoral method from a small incision up high under the lip is preferred. The only reason to use the eyelid approach is if a midface lift or suspension is being done at the same time.

From inside the mouth, a path is made up onto the cheek bone. It can be extended out onto the zygomatic arch if necessary. Sizers are used to determine what will look the best. The final implant is then inserted. Some plastic surgeons secure the implant in place with a small titanium screw, others do not. Closure of the incision is done with dissolveable sutures.

4. Is cheek implant surgery painful? How long does the swelling last?

I would not call it painful, rather it is more uncomfortable due to the swelling. Often there is some numbness of the cheek skin  which goes away in the first month after surgery. There rarely is any bruising because the surgery is very deep on the surface of the bone. Any bruising that occurs will not be seen on the skin but will present only as swelling. While remnants of swelling take six to eight weeks to completely go away, you will look fairly normal within two to three weeks. The initial abnormal fullness will have go away by then.

5. What are the risks and complications that can occur?

The standard surgical risks of bleeding and infection apply but they are very uncommon. The risk that is more significant and probably accounts for most instances of revision or secondary surgery is implant asymmetry or sizing issues. Because the cheeks have two sides, the placement of the implants must be perfectly symmetrical. That may seem easy but even slight changes in orientation of the implant may be able to be seen. Implants can also shift or slide downward towards the direction in which they were placed. Oversized cheek implants are especially noticeable because they can make the face look very unnatural. Cheek implants are always best done smaller than bigger.

One risk of having cheek implants is delayed infection, even many years later. This is caused by one specific event…dental injections. This can happen when your dentist is numbing your upper teeth. The needle can tract bacteria near or onto the implant. Advise your dentist if you have cheek implants.

6. I’d like higher cheekbones but I don’t want them to look fake. How can this be avoided?

There are many well known examples of famous people that look strange and overdone after facial rejuvenation surgery. In some of these cases, it is obvious they had cheek implants and it is because they are too big. This ‘error’ is most likely to occur when cheek augmentation for anti-aging purposes and are being used to fill out sagging cheek tissues. A cheek implant is not the same as a breast implant…its size should not be pushed to do too much.

7. I have very flat cheeks that extend down below my eyes. It makes me look sad. Will cheek implants help?

Having flat cheekbones can give the face a long drawn look that many may describe as sad. In the facial expression of smiling, we naturally see more prominence in the cheek area. When it is flatter it adversely affects how one’s smile looks. More fullness in the cheek allows a more  youthful look, whether one is smiling or not.

Dr. Barry Eppley

Indianapolis, Indiana 

Common Concerns about Cheek Implant Surgery

Sunday, December 20th, 2009

A face that has good skeletal contours, which some would call sculpted, is desired by many young men and women. The appearance of high cheekbones is one important element of achieving such a look. Cheekbones create a well-defined face by creating an upper facial prominence which makes the lower face look thinner. Such a facial look is seen as ‘model-like’ as is reflected in much of our society’s advertising.

In performing cheek augmentation, there are numerous typical questions that prospective patients may have about the procedure. In my Indianapolis plastic surgery practice, here are some of the most common.

Q: I am afraid if I get cheek implants that it may look unnatural. I have seen some Hollywood people that supposedly have them and they look fake. Will this happen to me?

A: That is an avoidable result. In choosing the right cheek implant for any patient, three factors are considered…the selection of the patient, the size and shape of the implant, and properly positioning them  during surgery. Not every person will benefit from cheek implants, the whole face must be considered. Rounder and fuller faces are not usually good candidates. There are different styles and sizes of implants available. As a general rule, it is always best to not overdo them. A subtle enhancement is more aesthetically pleasing than being too big. The implant must be positioned and secured over the curve of the cheekbone that is most deficient.

Q:  I want higher cheekbones but do I need to have a scar to get that look?

A:  All facial implants need an incision to be placed into the bone site. Surgical access to the cheek is done from inside the mouth high up under the upper lip so there is no visible scar.

Q: My face looks very flat. Do I need more than just cheek augmentation?

A: Some patients have more significant flattening of the middle part of their face that involves the upper jaw (maxilla) as well. While increasing cheek projection is helpful, that alone may not be enough. In this case, another set of implants can be placed along the paranasal area. (base of the nose) These two sets of implants can help bring out the entire middle part of the face into better balance with the lower jawline.

Q: What is the most common complication that occurs with this type of cheek surgery?

A: Implant asymmetry. Because cheek augmentation is a ‘paired’ surgery, both implants must be placed exactly the same. That sounds simple but slight differences in angulation and orientation of the implant may be able to be seen when the swelling subsides after surgery. This may require adjustment secondarily.

Q: How much time will I need off work to recover from cheek enhancement surgery?

A: Cheek implants will cause some obvious swelling but it is not significantly painful. Once can return to any type of work in one week but the cheeks will still be noticeably swollen. It will take at least two weeks before the cheeks will not temporarily unnatural.

Dr. Barry Eppley

Indianapolis, Indiana

Facial Implant Surgery on Indianapolis Doc Chat Radio Show

Saturday, June 20th, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  todays’s topic was facial augmentation.  The topic of facial implant surgery including what they are used for, how they are surgically placed, recovery from the procedures, and complications were reviewed. Chin, jawline, jaw angle and cheek implant types of surgery were covered. How one can tell if they would benefit from facial implant surgery and how such implants may enhance the overall appearance of the face were interesting topics of discussion.

Free plastic surgery consultations can be arranged by calling Dr. Eppley at IU Health North or IU Health West Hospital at 317.706.4444 or send an inquiry by e-mail to: info@eppleyplasticsurgery.com.

Important Concepts of Chin Augmentation in Women

Tuesday, June 2nd, 2009

Chin augmentation is a simple and successful plastic surgery procedure for bringing the lower face into better balance with the neck and upper face. How far to bring the chin forward and how to determine that prior to surgery are important questions. But an equally important question is the difference between men and women and the chin augmentation goals between the two. While no exact statistics are known, it is fair to say that at least one-half of chin augmentation patients are female.

The traditional approach (male) to chin augmentation is to bring the most anterior chin point to a vertical line dropped down from the Frankfort horizontal line. This essentially is like dropping down a line from one’s brow prominence. While this may look quite pleasing in profile in men, such an anterior point is often too strong for many women. It is usually not aesthetically pleasing to masculinize a woman’s profile too much. I have found a few woman that felt such a chin position was too much and their implants had to be downsized slightly.

While the profile position is the most commonly viewed in computer imaging and in before after photographs, it is not how most patients see themselves. While the profile view is relevant, it is the frontal or three-quarter view from which they see themselves far more frequently. Therefore, the shape of the chin is almost as important as how far forward it comes. It is perfectly acceptable in men to develop a broader or more square chin which can happen with extended or more wrap-around chin implants. In women, however, the use of less extended or more central implants should be considered. These will allow the width of the chin to remain much narrower than the body and angle of the jaw. In other words, keeping a more narrow chin which is consistent with a more feminine appearance.

The projection and shape of the chin are especially important considerations in female chin augmentation. A chin point that lies slightly behind the ideal vertical facial line and a more centrally-shaped chin implant will keep the chin more gender specific.

 Dr. Barry Eppley

Indianapolis, Indiana

Midfacial Implants – Different Styles for Cheek, Orbital, and Maxillary Augmentation

Friday, May 29th, 2009

Facial implants are a common and assured method of building out skeletally deficient areas such as the chin, cheeks, and jaw angles. While many are aware of these popular locations for esthetic facial enhancement, there are many more implant styles and locations than most envision. This is particularly true in the midfacial area.

The midface (between the lower eye sockets and the upper teeth)has the most complex external anatomical shape of any area on the craniofacial skeleton. From the prominences of the cheek bone to the concave surface of the pyriform aperture, no one single-shaped implant can be adapted to all of them. For this reason there are at least nine (9) different midfacial implant styles.

Cheek implants are the most commonly used midfacial implant. But there are four (4) different styles to choose from for the differing areas of esthetic deficiency on this bone. The standard cheek implant, also known as a malar implant, fits on top of the cheek bone and has a broad surface area that covers most of its surface area. The two (2) styles of this standard cheek implant differ in that the more extended version has a portion that goes up higher to make a smooth transition into the lateral orbital bone. For flat cheek bones, these implants styles will generally work well.

The submalar cheek implant, however, is indicated when the cheek soft tissues are a little droopy and the area under the cheek prominence is a little sunken in. This implant fits on the bottom or underside of the cheek bone which helps lift up sagging cheek tissues, fills out the submalar space and may even soften the deep nasolabial fold a little. The submalar cheek implant comes in two styles which differ in how much fullness is added to the submalar space.

The tear trough midfacial implant is a specialized lower orbital rim (eye socket) implant. It augments the depressed suborbital groove that some people have naturally or develops from aging and tissue atrophy. This groove runs between the inside of the eye across the lower orbital rim often ending below the cheek. While some use fat injections for augmentation of this area, a carefully placed tear trough implant provides permanency to this contour problem.

The pyriform aperture implant fits along the bone which forms the side rim of the nasal cavity. It is designed to build out the base of the nose where the side of the nostril meets the lower cheek tissues. I have most commonly used this implant in secondary cleft surgery to build out the deficient bone area where the cleft went through. While bone grafts are commonly used for this problem, the pyriform aperture may still remain depressed even with a well done bone graft.

The premaxillary or peri-pyriform implant builds out the entire base of the nose from one side of the pyriform aperture to the other. This includes anterior nasal spine area as well. For very flat midfaces, this implant can really help provide augmentation to the nose and upper lip.

The nasolabial or melo-labial groove implant fits onto the bone to the side of the nose and helps soften or build-out the very deep nasolabial fold or groove. Rather than using temporary injectable fillers placed beneath the skin, this implant placed on the underlying bone serves to provide the same push.

The Lefort or maxillary implant, the least common of all midfacial implants, is designed to be used during or after a LeFort I osteotomy. This implant would fit above the osteotomy line so that the midface would not look more deficient as the maxillary teeth come forward.

All midfacial implants, while being very different in shape and indication, share two common features. First, they are all placed from an incision inside the mouth so no skin incision is ever needed. Secondly, they are all best secured into position with a screw as their position is critical in getting the desired esthetic result.

Dr. Barry Eppley

Indianapolis, Indiana

Cheek Implants for the Aging Face

Wednesday, April 8th, 2009

One of the common facial aging changes for some people is the loss of fullness in the middle of the face and a longer distance between the height of the lower eyelid and the prominence of the cheek. This is most apparent when you look in the mirror and notice a flattening of the cheek area and a hollowed out look around your eyes.  This occurs as the soft tissue of the cheeks, much like the jowls and neck skin, goes south due to gravity and skin loosening. The specific anatomic reason is that the ligaments that attach the skin to the bone weakens  or stretches out and the skin that is stretched out over the cheek bone falls. This can also appears as folds or festoons of skin that hang down from the lower eyelid to below the cheek.

 To improve  this cheek ‘deflation’, adding volume through cheek implants is one approach. By ‘re-inflating the cheek by putting an implant underneath it, the cheek tissue is lifted back up and the cheek highlight or prominence is restored…or even made more evident. In my Indianapolis plastic surgery practice, I perform cheek implantation by making small incisions inside the mouth above the gum line with no visible external incisions and this is my preferred approach in my Indianapolis plastic surgery practice. Cheek implants can also be placed through a lower eyelid incision but this is prone to placing the implant too high. There is no evidence in the medical literature or in my experience that an increased infection risk exists by going through the mouth.

This relatively simple surgery gives a notable richness to the face resulting in a more rejuvenated look. The face also seems to age better after cheek augmentation as the implant helps lessen the potential for future sagging. Cheek enhancement can be done at the same time as a facelift, resulting in a dual change that can be more significant.

In the use of cheek implants in the aging face, it is common to see it overdone. Too much cheek enhancement can look unnatural and be apparent that something was done. A subtle change is more natural and less obvious. Cheek implants come in a variety of sizes and shapes and it is far better to use a small or the smallest size. Because it is done on both cheeks, the after surgery effect can be more than one would expect. Unlike the naturally deficient (underdeveloped) cheek patient, who usually needs a bigger size, the aging face does not usually have a bone deficiency but a much thinner soft tissue prolapse.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Correction of Chin Ptosis

Saturday, April 4th, 2009

A chin that sags over the line of the jaw (chin bone) is called chin ptosis. (ptosis is medically defined as a sagging of a body part) While some people have this naturally, most of the time it is due to the soft tissues of the chin sliding downward for a reason. This can occur from simple aging, loss of one’s lower front teeth, and due to different surgical procedures of the chin. A few people actually have pseudo- or perceived chin ptosis which occurs as a result of a natural deep crease below the lower lip (submental crease) which makes the chin look ptotic (particularly when smiling) even though it is not.

Successful correction of chin ptosis can usually be done for those problems caused by prior surgeries. Chin surgeries that are well known to cause soft tissue sagging include the intraoral placement of implants, removal of an overly large implant and bony reductions. Other less common causes include intraoral access for repair of mandibular symphysis and parasymphyseal fractures and vestibular lowering procedures (preprosthetic surgery) in preparation for improved lower denture fit.

Treatment is  based primarily on resuspension or tightening of the mentalis muscles  with or without hard tissue chin expansion. For sagging caused by intraoral access to the chin, the mentalis muscles must be brought back up into their original anatomic position. The intraoral route of access to the chin always divides the upper attachments of the mentalis muscles. (some surgeons put them back well while others do not) This is why the submental (under the chin) skin approach for chin implants is always better with a very acceptable scar and why I use it in my Indianapolis plastic surgery prasctice.  It is not always easy to find good muscle to sew to and this is why a bone-anchoring technique with titanium screws or Mitek suture anchors is my preferred method for a ‘high’ reattachment.

If chin implant removal is the cause of sagging, replacement with a new implant alone may be satisfactory. Or if the patient no longer wants an implant but still desires an augmentation, moving the chin bone forward as a natural ‘implant’ may create enough expansion to fill out and elevate the sagging chin tissues. A chin osteotomy is an excellent opportunity to elevate the muscles as well as the plates and screws used to hold it in its new place are good anchoring points for the muscle.

Chin reduction procedures are especially prone to chin sagging problems after. The lower attachments of the mentalis muscle must be divided to access the chin bone. Once the bone is reduced by burring, the muscle and sometimes skin must be shortened and reattached. Usually tightening the muscle across the reduced bone and reattaching it to the muscle on the underside of the chin is adequate. If not, bone holes can be made on the inferior ledge of the chin bone onto which the muscle can be reattached.

 he chin is unique in that the mentalis muscle is attached and suspended across it  both above and below the chin prominence. The skin and fat are attached to the underlying muscle and follow its position on the bone. If the muscle sags, so does the appearance of the chin. The key to correction of chin ptosis is management of the mentalis muscle attachments in most cases.

Dr. Barry Eppley

Indianapolis, Indiana

Cheek Implant Complications and Their Revisions

Sunday, December 14th, 2008

Cheek implants are one of the more common types of facial implants used for esthetic or reconstructive enhancement of the malar area. They are second in use only behind chin implants which are the most common implant placed on the facial bones. Like all implants, they have the potential for some complications such as infection, shifting and asymmetry, and poor sizing and positioning. Cheek implants also have a few unique complications as well.

Infection from any type of facial implant is possible but it is very uncommon. The extensive blood supply of the face and the implant’s position at the bone under a muscle layer make infection uncommon. In the very few that I have seen, reopening the implant pocket, cleaning off the implant thoroughly and immediately reinserting it has always worked with smooth silicone rubber implants. Porous type implants are another story because it is not possible to rid the bacteria which are embedded in the irregular deep channels of a porous surface. Cheek implants made of these materials should be removed and replaced at a later date.

Cheek implants are unique from many other facial implants because they are positioned ‘on the side of a cliff’ so to speak, with no natural resting place. Only the soft tissue pocket developed on the bone becomes their containment method. Because a pocket must be developed that is bigger than the implant to allow it to slide into place without folding or bending of its edges, it is possible for cheek implants to slip around and be different between the two facial sides. This is probably the number one complication related to them….asymmetry. Persistent asymmetry over time can also lead to eventual migration of the implant down to and through the mouth incision which is commonly used for their placement. To prevent shifting of the implant after surgery, I prefer to ‘nail’ the implants into place with a small screw through them into the underlying cheek bone once the position I want is assured.

Aesthetically, cheek implants are often oversized in my opinion. What makes a significant change on the operative table can often be too dramatic to the patient later. The cheek is a unique three-dimensional facial unit that defies a precise measurement or method of implant selection. (the chin is very straightforward in this way) Computer imaging of the cheek, unlike the chin or nose, is more artistic than scientific and does not help in selecting a size or shape of a cheek implant. A subtle augmentation or increase in cheek size is almost always better. Don’t try and make a cheek implant do too much. Fortunately, downsizing of a cheek implant is a simple replacement surgery that is much less traumatic than the original surgery. Re-entering the same pocket without extra dissection makes adjustment surgery usually easier.

Revisions of problematic cheek implants with a satisfactory outcome can usually be done by changing the size and shape of the implant or repositioning it with more secure fixation to the bone. Cheek implants, however, are highly critically assessed by most patients and meeting their aesthetic demands of size, shape, and symmetry make them one of the most challenging of all the facial implants for a satisfactory outcome.

Dr. Barry Eppley

Indianapolis, Indiana

The Use of Infra-Orbital Rim and Cheek Implants

Friday, November 14th, 2008

Deficiencies of the lower rim of the eye socket and cheek create a hollowed-out appearance. Some call this a tear-trough deformity although this is not really accurate. A tear trough deformity is a depression between the eye and nose, technically known as the nasojugal fold. Underdevelopment or underprojection of the lower orbital rim and cheek is part of a more global midface issue, with a flatter bone profile across this area. This can be evidenced in a profile photo by dropping a vertical line from the lens of the eyeball downward. If the cheek and orbital rim is behind this line, the bone is deficient. Correction of combined orbital rim and cheek deficiencies is most predictably done with implants.

 

There are several types of implants for the orbital rim. Some extend from the orbital rim towards the nose and down into the tear trough, some extend out from the rim to the cheeks, and others connect the orbital rim to the outer corner of the eye. Pre-formed orbital rim implants are currently available in solid silicone as well as polyethylene. (Medpor) Implants can also be hand carved out of a block or sheet of Gore-tex. (PTFE) I do not believe that the material used makes any difference. It is more important to have the right shape implant in good position than anything else.

 

Orbital rim implants are best placed through a lower eyelid incision directly onto the bone. This is an obvious way to go if the patient needs skin removed from the lower eyelid as well. It is possible to place them through the inside of the eyelid (transconjunctival approach) but this is more difficult. Lifting up the periosteum of the bone is important so that a cuff of tissue can be used to cover a part or all of the implant. Bringing tissue back up over the implant is important to prevent the edges of the implant from being visible. This is particularly important in those people with thin lower eyelid skin, which seems to be most people who have bone deficiencies in this area. I always secure the implant to the bone with small tiny screws so that it will never move. You will always be able to feel where the implant is as there is little tissue between the implant and the skin in the eyelid area. Most importantly, you just don’t want to be able to see them through the skin. Often I will place a strip of fat or transpose lower orbital fat over the implant to get better coverage.

 

The key to a good result with orbital rim implants, with or without a cheek extension, is to not overdo it. The improvement is better to be subtle and not dramatic. It doesn’t take very much implant thickness, just a few millimeters, to make a real visible change in the eye area. Large orbital rim implants, while producing better correction, are often visually detectable and, at the least, very palpable.

 

Because adjusting an orbital rim implant is like repeating the original surgery in its entirety (reopening the whole lower eyelid), I prefer a dual implant approach to the orbital rim. One implant across the orbital rim (placed through the lower eyelid) and a cheek implant placed high up to the orbital rim, touching its edges. This way adjustment of the implants may be easier, particularly when they become scarred into place.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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