Q: Dr. Eppley, if one has cheek implants (malar implants) placed high up and towards the lower orbital rim can this raise the lower eyelids a bit? Or result in decreased scleral show? I am hoping this is true.
A: I would never count on any any type of malar/cheek implants or orbital rim augmentation being able to raise the lower eyelids or decrease scleral show. Logically that would seem like it would work but that has not been my experience. What drives up the position of the lower eyelid from a scleral show standpoint is the support that lies within the eyelid itself (adequate vertical tissue support) combined with medial and lateral canthal positioning.
While cheek implants push up the overlying cheek tissue that does not translate to the lower eyelid. The lower eyelids can usually only be vertically elevated by the use of spacer grafts placed within the lower eyelid or reattaching the outer corner of the eye up higher in the lateral orbital rim. That is not to say there might not be some supportive effect from elevation of the cheek tissues but it is just not a major one or one that can work completely on its own.
Dr. Barry Eppley