Q: Dr. Eppley, I had submalar implants (Binder silicone submalar implants) done one year ago, large size. I could not smile fully, corners of my upper lip did not go high enough, so I had them removed 3 months ago. Now, everything is fine with my smile, and I would like to have submalar implants again, may be smaller size.I would like to ask few questions: Is it common that patients which use submalar implants have difficulties with smiling or that smile looks different that before? Can it be due to too large size used in my case or…?
A: While this is not a problem that I have ever seen from submalar implants, it is theoretically possible. Unlike malar implants, a significant portion of the submalar implant hangs down off of the bone. Given that the levator anguli oris muscle runs from the corner of the mouth up to the cheek bone and its contraction is responsible for lip elevation, it is easy to see how a large submalar implant could interfere with its action. It is either that or the sheer size of the implant simply interfered with mass tissue movement. (more likely) Either way, your experience demonstrates that it happened as proven by a return to a normal smile with their removal. While I have no idea what size submalar implant you had or exactly where on the bone it was placed, I suspect that a smaller size implant would be less likely for this problem to recur.
Dr. Barry Eppley