Tear troughs and deep grooves under the eyes are often the result of underdeveloped or a weak skeletal structure. Specifically these would be the inferior orbital rims and the anterior cheek bones which sit at the bottom of the lower eyelid and supports the upper cheek soft tissues. Treatment of undereye hollows and grooves is most commonly done by injection techniques using either synthetic fillers or the patient’s own fat. While successful for some patients, not all experience the type of result they want or gets a result that is sustained.
Permanent and assured augmentation results in the face are achieved with preformed synthetic implants for select bony areas. While many styles and sizes exist for the commonly implanted areas of the chin, cheeks and nose, there are no implants that are commercially available for the inferior orbital rim. Given the new demand for augmentative treatments of this area, there exists a need for a preformed infraorbital rim implant for those patients who desire a permanent treatment method.
An infraorbital rim implant should provide superior and anterior projection along the bony rim from the naso-orbital junction out to the cheek. It only needs to be a few millimeters thick (2 to 4 mms) to make a noticeable difference. The naso-orbital junction is important as this represents the tear trough area which is a frequent aesthetic concern. How far out onto the cheek the implant should go can be debated but most infraorbital rim deficiences also involve a portion of the zygoma as well. However its lateral extent should be limited to the anterior aspect of the cheek. (zygoma) If it extends out further a ‘bump’ will often appear in the side of the cheek.
The infraorbital implant is best placed through a lower blepharoplasty (eyelid) incision. While it can be placed through an intraoral approach, getting around the large infraorbital nerve is difficult and will create a postoperative period of lip and cheek numbness which hopefully is self-resolving. A lower eyelid skin-muscle flap provides direct access to the infraorbital rim and permits precise implant positioning and small screw fixation. This creates no more trauma than a lower blepharoplasty surgery. Like a lower blepharoplasty it is important to resuspend/reattach the orbicularis muscle over the lateral orbital rim during closure, and use a lateral canthopexy if necessary, to prevent any postoperative lower eyelid contraction deformities. (ectropion)
The need for an infraorbital rim facial implant has been driven by the popularity of injection treatments for lower eyelid hollows and tear troughs. It offers a permanent treatment option for those who do not want injections or have failed previous injection treatments.
Dr. Barry Eppley
Indianapolis, Indiana