There are numerous aesthetic implants for the midface that are well known including cheek, tear trough and paranasal implants. While effective in the properly selected patient these standard facial implants provide spot augmentations meaning that only a portion of the facial bone area is being enlarged/expanded. For larger areas of midface augmentation these standard implants can be combined either overlapping them or having them placed close together.
The use of multiple standard implants for an overall midface augmentation effect has today been surpassed by the design of custom midface implants. This implant covers the entire midfacial bones from the maxilla, pyriform aperture, infra/lateral orbital rim and zygoma in endless variations and thicknesses based on each patient’s specific aesthetic needs. This creates the equivalent of a smooth LeFort III effect without the lower dentoalveolar component. Such an implant design essentially pulls the whole midface forward and is ideal for the midfacial hypoplasia patient who has a satisfactory occlusion. Most custom midface implants can be placed through an intraoral incision exclusively.
One of the custom midface variations is to have the design go up along the lateral orbital rim to the tail of the eyebrow. When the implant goes this far superiorly proper placement can not be achieved by the intraoral approach alone. A lower eyelid incision may help but it really takes an upper eyelid incision to get the tails of the implant in proper position. A 10mm lateral eyelid incision provides access to the frontozygomatic suture lines and lateral eyebrow. The upper tail of the implant can be pulled through the incision and made sure its placement is high enough as per the design.
Once implant positioning is assured a single micro screw is used to secure it to the rim. The incision is closed with fine 6-0 plain sutures.
Such upper eyelid incisions usually heal inconspicuously as seen in this patient one year later.
Such large surface area coverage custom midface implants may require more than just an intraoral incision to properly place. The small upper eyelid incision is useful when the implant wraps around the lateral orbital trim and goes superiorly. The lower eyelid incision is needed when there is a long extension to the custom midface implant out onto the zygomatic arch.
Dr. Barry Eppley
World-Renowned Plastic Surgeon