The undereye area has become a focus of aesthetic attention for the management of tear troughs and hollows. Some of these occur as a result of aging and others have a more congenital origin which then becomes more apparent with aging. Treatment for aesthetic under eye issues is fundamentally about adding volume. Injectable fillers and fat are the mainstays of this volume addition with the adjunctive use of lower blepharoplasty skin removal if needed.
While the injectable management of undereye contour issues cam be very effective, it does not work well for some patients. It is particularly ineffective for true infraorbital bone underdevelopment which is associated with a negative orbital vector. In these cases an infraorbital rim bone augmentation using an implant would be best. While a surgical procedure it provides permanent smooth rim augmentation whose volume retention is assured.
Infraorbital implants is an uncommon facial implant and, as a result, the differences in the style options is rarely appreciated. They come in three styles, one performed and the other custom made. Most surgeons are aware of tear trough implants or what I call type 1 infraorbital rim implants. These are preformed implants that comes in three basic sizes, differing largely in their These are designed to fit on the front edge of the infraorbital rim and provide horizontal projection. The do effectively improve the classic tear trough deformity at the medial orbital rim by a release of the arcus marginalis and the addition of volume. But they do not provide any vertical rim augmentation and do not extend out into the malar region. Attempts at trying put their upper edge above the level of the existing infraorbital rim bone will result in a palpable and potential visible edge in the thin tissues of the lower eyelid.
The type 2 infraorbital rim implant covers both the infraorbital rim and extends out onto the cheek. It provides a vertical as well as a horizontal rim augmentation effect and extends from close to the nasal bones medially out onto differing locations in the cheek laterally. It is custom made so a wide range of dimensions and surface area coverage are possible based on the aesthetic needs of the patient. It is the ideal design for augmenting an infraorbital rim bony deficiency as there is always associated cheek flatness as well. As a result it creates a smooth and harmonious flow of augmentation across this very visible facial region.
Custom infraorbital rim implants can also be made to just cover the infraorbital rim area only, providing vertical rim augmentation. (type 3 infraorbital rim implant) This is the least commonly used type of infraorbital rim implant. Such isolated vertical augmentation could only be effectively done in a custom made process.
Augmentation of the infraorbital rim area can not be accomplished with a single implant style for the range of anatomic deformities that occur and to achieve satisfactory aesthetic outcomes. Understanding the differing options of this unique facial implant can be a good complement to injectable treatment strategies.
Dr. Barry Eppley
Indianapolis, Indiana