The cheeks occupy a prominent aesthetic position in the midface. They create some amount of facial prominence/angularity as they curve around between the eye and the side of the face. While the cheek is often perceived as an isolated circular area by the side of the eye, as is commonly seen in the shape of most standard cheek implants, this is not how this facial area is anatomically constructed.
The cheek or malar region is an aesthetic term of which its bony anatomy is more extensive than the name implies. The zygomatico-maxillary-orbital bone complex is the bony foundation of the cheek. It is not an isolated bony area but a long stretch of bone that runs from the temples posteriorly to the infraorbital rim. This can be appreciated by those people who have or seek the ‘high cheekbone’ look.
It should be not surprise, therefore, that undereye hollows are associated with flatter cheeks as well given that they are part of the same bony region. When treating undereye hollows by implant augmentation it would be very uncommon that infraorbital augmentation is done alone. It is always best done by more of a wraparound implant design that provides a continuous and blended stretch of augmentation which is the anatomic basis for custom infraorbital-malar implants.
Custom infraorbital-malar implants are placed through subciliary lower eyelid incisions. This provides the most direct access for the linear dissection that is needed from the nasal bones medially to the posterior end of the zygomatic arch. It is interesting how long or large such an implant can look when placed on the face compared to how it looks on the bone in a 3D design.
Saddling on the infraorbital rim rather than just sitting in front of the bone is part of the smooth continuous design and is an important design feature than provides the best improvement in undereye hollows. This part of the implant is secured to the infraorbital rim with small microscrews. Assuring a good fit along the infraorbital rim is critical as this determines how the long hidden wings of the implant over the zygomatic body and arch will be positioned.
Dr. Barry Eppley
Indianapolis, Indiana