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Custom implants can be designed for may different aesthetic facial needs. While they are most commonly perceived as being used for the midface (cheeks ad infraorbital rims) and lower face (chin and jawline) they are also used for the upper face as well. Forehead and brow bone augmentations can be done with custom implant designs just as effectively as the mid- or lower face. And in most cases custom upper facial designs are more needed as there are no standard implant designs for them.

One of the unique areas of aesthetic upper facial augmentation that custom implants are uniquely suited to treat is the periorbital region. Composed of the superior orbital rims (brow bones), the infraorbital rims and the connection between the two (lateral orbital rims), the circumferential bony rim of the eye poses unique challenges for augmentation. Besides getting a good fit to the complex contours of the orbital rim, getting the implants into place with limited incisional access and acceptable scarring are not easy in this part of the face.

Patients that want to augment the periorbital region do so for lack of rim support to the eye. The eye may look too exposed or open. The cornea may almost be more froward the orbital rims above and below it. This is seen as deficient brow bones superiorly and infraorbital hollows and a negative orbital vector in profile. A near circumferential orbital rim augmentation can be done with what I call the Custom Eyemask Implant design. This augments almost the entire orbital rim only leaving out the medial orbital rim which rarely needs to be augmented.

To place the Custom Eyemask implant it is necessary to have a split design, which makes it a three piece implant to be surgically placed. The implant is designed with a geometric split along the lateral orbital rims. Thus when surgically placed the larger brow bone implant can be inserted endoscopically through a small scalp or forehead incision. The two infraorbital implant pieces can be placed through lower eyelid incisions at which all three pieces can be ut back together at the level of teh lateral canthal incisional location.

The Custom Eyemask implant offers the only circumferential orbital rim augmentation method. It is uniquely able to provide horizontal augmentation to further cover and protect the eye at its superior, lateral and inferior rim areas. It is designed to be able to be separated into three pieces for surgical placement with limited incisions and then reassembled inside the tissue pockets.

Dr. Barry Eppley

Indianapolis, Indiana

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