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One of the best midface augmentation methods is that of the custom infraornital-malar (IOM) implant. While lesser known that injectable fillers and fat or standard tear trough implants, this unique implant style provides simultaneous treatment of undereye hollows and infraorbital deficiencies as well as providing cheek augmentations as well. It provides a horizontal line of midface augmentation that overlies the natural pattern of the bone in this facial area.

While many cheek implants are placed through an intraoral incisional approach, this works because the implant has a primary cheek augmentation effect (albeit low) and does not have any infraorbital effect at all. But an IOM implant has a significant infraorbital effect in which accurate placement onto and along the bony infraorbital rim is critical. For this reason the best incisional approach is a direct line through the lower eyelid.

But the lower eyelid incision should not be confused with a traditional blepharoplasty incision. It is different in many ways and, as a result, does not have the same risks associated with it. A very significant way it is different is in the type of patient on which it is performed. Unlike typical older patients that gets lower blepharoplasties, the IOM implant patient is usually younger with stronger lid tissues and the procedure being done is additive (placing support to the lower eyelid) vs reductive as in a blepharoplasty. (removing tissues) 

While this are strong points that demonstrate tissue composition differences an equally significant is in the extent/length of the incision. While a lower blepharoplasty incision typically crosses the whole extent of the lower eyelid, the IOM implant incision stops at the midpoint of the lower eyelid.  It generally stops at vertical line dropped down from the pupil, thus it is called a hemi lower eyelid incision. By limiting the extent of the incision less orbicularis muscle is disrupted which preserves lower eyelid  support.

When all of these factors are put together the lower eyelid  incision used in custom IOM implants is different than that of the traditional lower blepharoplasty incision used in periorbital rejuvenation. As a result it is not associated with the same risk of lower eyelid malposition.  

Dr. Barry Eppley

World Renowned Plastic Surgeon

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