Introduction
Orbital frame or combined brow bone and infraorbital augmentation is a powerful upper-to-midface structural enhancement implant approach. A combined supraorbital (brow bone) and infraorbital rim augmentation addresses deficiencies on both the upper and lower orbital rims. This creates a stronger, more defined orbital frame, balances projection, and corrects negative vector or recessed midface features.
Why Combine Brow Bone + Infraorbital Augmentation?
1. Enhance the entire orbital frame
Most patients with infraorbital deficiency also have some degree of supraorbital/brow bone under-projection, giving the eyes a rounder, more open appearance. Augmenting both rims creates a more proportionate frame.
2. Improve aesthetic traits
- Stronger, more defined brow contour
- Reduced “bug-eyed” or prominent-eye appearance
- Better support for both upper and lower eyelids
- Smoother transitions around the periorbital skeleton
3. Correct congenital aesthetic deficiencies
Dual rim augmentation is useful for:
- Congenital weak orbital rims
- Periorbital hollowing or midface retrusion
- Masculinization or feminization depending on contour
Anatomy Overview
Supraorbital Rim / Brow Bone
- Defines the upper orbital border
- Contributes to brow projection and upper eye shadow
- Key for masculine aesthetic (more projection)
- Key for feminine brow shaping (finesse contour, not bulk)
Infraorbital Rim
- Defines lower orbital border
- Supports lower eyelid
- Affects tear trough depth and negative vector
Together, these rims create the periorbital skeletal frame that determines how deep-set, balanced, or forward-set the eyes appear.
Custom Implant Design
There are no standard implants that can wrap around the orbital bones, high or low, so they must be custom made. While different implant materials are available solid silicone is preferred over PEEK and Medpor because
- It is easily placed through small incisions, reversible, and modifiable
- Provides a smooth contour with feathered edging
- Designed and can be visualized after surgery on a 3D CT scan
- Allows for interlocking multi piece implant designs
- Allows for secure fixation with microscrews anywhere along the implant design
Surgical Approach
Incisional Access
- Brow Bone Implant – hairline incision, possibly upper eyelid lateral crease incision
- Infraorbital Rim- Cheek Implant:lower eyelid (subciliary) incision
When performed together, surgeons typically start with the supraorbital rim (for superior frame shaping) then the infraorbital rim for lower frame support.
Aesthetic Outcomes
Expected Improvements
- Stronger brow projection / more defined supraorbital ridge
- Smoother lower eyelid–cheek junction
- Reduced eye prominence (“deepening” effect)
- Better midface projection ratios
- More balanced masculine or feminine orbital contour
Great for:
- Masculinization (more robust ridge + stronger midface)
- Feminization refinement (smoother, controlled brow contour + improved support)
- Photogenic, shadowed orbital framing
Case Study
This male desired an upper facial augmentation that brings his orbital frame and cheek bony complexes forward to be more proportionate to the facial bones beneath it. He had a prior history of PEEK infraorbital rim implants placed intraorally but their effect was limited. A 3D CT scan showed the implant placement and their small size.
For a much greater and comprehensive effect custom brow bone and infraorbital-malar implants were designed top provide a complete augmentation effects of upper and lower orbital rims as well as the cheeks. While designed as a one piece implant it could never be placed as such. As a result a keyed interface was made along the lateral orbital rim to allow the implants to be made in three piece as well as so placed.
Through a1.5cm scalp incision right behind the frontal hairline the brow bone implant was passed through then incision vertically and then re-oriented in its horiozontal axis as it was designed over the brow bones. The key is to get enough dissection along the lateral orbital rims to allow the lateral orbital extensions of the implant to be the fully laid out.
Through an intraoral incision the PEEKimplants were unscrewed and removed along with the extraction of the buccal fat pads. The to be placed custom infraorbital-malar implats were used as a comparison.
The size and shape of the removed PEEK implants was directly compared to the new custom infraorbital-malar implants.
The custom infraorbital-malar implants were placed through lower eyelid incisions. The brow bone and infraorbital implants were united over the lateral orbital rims and secured there with a single microscrew through a small incision at the lateral crease of the upper eyelids.
To complement the custom periorbital frame implants a perforated silicone nasal implant was placed through an intranasal approach technique.
The immediate effect of the combined custom orbital frame and nasal implants is to pull the entire midface forward. When cobering such a large surface area of bone a few millimters of projection can have a major facial effect.
Discussion
A custom orbital frame implant is a 3D-printed implant created from a patient’s CT scan to augment or reshape the entire periorbital skeletal framework. Unlike single-piece supraorbital or infraorbital implants, a frame implant can span from the brow ? lateral orbit ? infraorbital rim ? midface, giving seamless contour enhancement.These designs are used for aesthetic enhancement often in patients that may have a negative orbital vector.
A true frame implant ties these zones into a continuous 3D structure, offering superior shape control compared to separate implants.
The expected aesthetic outcomes include:
- Stronger brow projection / more defined supraorbital ridge
- Smoother lower eyelid–cheek junction
- Reduced eye prominence (“deepening” effect)
- Better midface projection ratios
- More balanced masculine or feminine orbital contour
Custom orbital frames allow shaping that enhances:
- Brow shadow depth
- Lateral orbit “sweep”
- Infraorbital support to reduce scleral show
- Smooth lid-cheek junction
Great for:
- Masculinization (more robust ridge + stronger midface)
- Feminization refinement (smoother, controlled brow contour + improved support)
- Photogenic, shadowed orbital framing
The relevant design principles for custom orbital frame implants are:
A. Integration with Native Anatomy
Using the patient’s CT scan to:
- Map rim deficiencies precisely
- Match curvature of the orbital bones
- Avoid the supraorbital notch/foramen and infraorbital nerve
- Maintain eyelid and canthal tendon support
B. One-Piece Segmented Design
- Supraorbital ? lateral ? infraorbital in a continuous sweep
- Brow and infraorbital pieces keyed together
- Best for severe negative vector or global deficiency
Key Points
1) Orbital frame implants cover the upper and lower orbital rims providing a near 270 degree augmentation effect.
2) A segmentalized two piece implant design is used which requires limited incisions of the hairline, upper and lower eyelids for placement.
3) The custom orbital frame implant is often combined with other types of facial augmentation, either before, during or after, for more complete facial enhancements.
Barry Eppley, MD, DMD
World-Renowned Plastic Surgeon