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Custom infraorbital implants provide superior augmentation of the lower orbital-upper midface skeletal due to its 3D design. Augmentation of many infraorbital rim deficiencies often requires a combined vertical and horizontal augmentation which standard infraorbital implants can not do. In addition they can provide coverage for the lateral orbital rim or malar areas as well for a more complete skeletal correction if needed.

The thinnest part of any infraorbital rim implant is its medial arm or extension across the infraorbital rim to the nose. This is the most precise location for implant placement as the lower eyelid tissues are very thin and the most medial edge of the implant in this area must be paper thin with an exact positioning to avoid any visible or palpable bulge or contour irregularity.

Should the medial rim end of the infraorbital rim implant have a detectable edge the question becomes what is the best way to revise it. The first question is why is the edge of the implant detectable. It is because it is off the rim a bit or the pocket didn’t get developed fully and the very end of the implant is buckled (positioning) or is the medial end in good position but is too thick? (design)

Regardless of the cause or the original incisional access used for placement the best revisional approach is direct. Through a small medial subciliary lower eyelid incision just superior to the bulge the implant can be readily located and the problem corrected. Whether it needs repositioning, implant modification or further pocket development this can be done under direct vision.

After the medial wing of the implant is adjusted it may be  to secure it down go ensure it is as flush to the bone as possible. Placement of a small self-tapping screw works well to do so.    

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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