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Cheek implants have been around for almost fifty years in various shapes and sizes. As an off-the-shelf implant it can create different cheek augmentation effects over the main body of cheekbone as well as the submalar area just beneath it. Depending where on the cheek the implant is placed and its size it can create a relative deficiency above it along the infralateral orbital rim area. This stepoff from the implant is often palpable to the patient and equally often visible as well.

This orbital rim deficiency is the result of the cheek implant providing only a selective area of augmentation (aka spot augmentation)…which is what standard implants do. By augmenting one facial area it can make in some cases a deficiency in the shape of the facial areas around it pafticularly if there is not a feather edge transition from implant to the bone. Providing the cheek implant has produced a desirable aesthetic effect a more complete augmentation requites adding a new implant above it. One option is to convert the cheek implant to a custom cheek-orbital rim implant design. The other option is to add above it additional implant.

A good option for this selective orbital rim augmentation is the tear trough implant.  While designed to treat the aesthetic suborbital groove deformity located more medially it can also be effective for a variety of other limited rim defects.

By moving the tear trough implant from its standard location to a more lateral one above the cheek implant the step off is eliminated. During surgery the only ‘debate’ is whether to place the lower edge of the tear trough implant where it intersects with the cheek implant above or below it from a lowe eyelid incision. As a general rule the inferior edge of the tear trough implant is usually best placed below the cheek implant to lessen the risk of an edge transition deformity.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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