Augmentation of the bones of the face can be done for a wide variety of aesthetic purposes. This serves as the foundation for the most common sites for implant placement of the chin, cheeks, jaw angles, nose and infraorbital rims. But just because a performed implant does not exist for other facial sites does not mean they can not be augmented as well.
One such example is that of the lateral orbital rim. For deeper depressions along the side of the eye the lateral orbital rim can the augmented by pushing off of its bony surface with an implant. The patient motivation to do so may come for having had cheek or infraorbital rim augmentation where by comparison the lateral orbital rim area now looks deficient by comparison or it could be just that of a normal developmental aesthetic deficiency.
Through a small lateral canthal skin incision a lateral orbital rim implant can be placed. There are no such preformed implants so other types of implants must be modified for use. I prefer to employ either a performed tear trough implant or the use of ePTFE sheeting. Tear trough implants make the most sense since they have a natural curve to them with very feathered edges and can be easily trimmed to fit the bine area of coverage needed. Because most patients will not require an implant thickness greater than 2 to 3mms, this also fits well into what they can provide. Trimming he implant to fit the bone footprint needed and microscrew fixation make for an adaptable and secure fit.
Dr. Barry Eppley
Indianapolis, Indiana