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Infraorbital rim implants are an underappreciated method of augmentation of the lower eyelid area. Traditional lower eye implants are preformed and best described as horizontally increase the projection of the infraorbital rims. While this is effective for some lower eyelid issues, such as tear troughs, it only provides limited benefit by virtue of its one dimensional effect.

A more complete and effective infraorbital rim implant style comes from a custom design approach. This usually creates an implant that has a saddling design which means it straddles the rim. By so doing a three dimensional augmentation occurs by changing the vertical and horizontal projection of the rim. It also allows and is usually necessary to extend the implanted design out onto the cheek to some degree for an implant that flows smoothly and naturally into the surrounding skeletal structures.

One very relevant question with custom infraorbital implants is how they are surgically placed. The two options are either through the eyelid or through the mouth. Each has their own advantages and disadvantages. But the most important need that must be met with either approach is whether it permits the best placement/positioning of the implant.

As a general rule custom infraorbital implants that have a ‘significant’ saddle will need to be placed through an eyelid incision. This will allow the subperiosteal dissection needed along and inside the orbital rim to be done for the implant to be placed as designed. This is not possible when coming from below in an intraoral approach.

It can be debated as to how significant this implant rim saddle has to be. But when a true saddle design exists it is of most importance that it sits properly as it is designed.

Three-quarter infraorbital rim saddles can be successfully placed intraorally. This will require extensive dissection around the infraorbital nerve so the patient should be prepared for some significant infrarbital nerve numbness which will take some time to resolve.

Dr. Barry Eppley

Indianapolis, Indiana

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