Infraorbital Implant Removal
Q: Dr. Eppley,I talked to my surgeon and he explained some of the difficulties that may come of infraorbital implant removal. You see I had it done together with a SOOF lift and lower eyelid retraction surgery and so removing the implant might compromise the support of the lower eyelid area. I wanted to ask some tentative questions in case I go ahead with removal:
-How would you handle the risk of undoing the lower eyelid surgery I’ve had done and prevent any adverse effects that might require further surgery in the future?
-Is my surgical case very uncommon or something you have experienced before?
-If I am unlikely to return completely to my previous look, what type of change is reasonable to expect, or perhaps that’s impossible to say?
At one month after surgery there is still some swelling but I believe I am correct that the sharp edges I see below my eyes are indeed the implant as it’s quite palpable. Just to be sure though I’ve attached two recent pictures and two of my face before surgery if you have the time perhaps you could take a quick look and tell me if there is any hope at all that this issue will resolve itself?
You correctly assumed the incision method and the size of the implants should be relatively small but they appear quite prominent, maybe because of the thin skin in the area. I forgot to mention that these are “extended infra-orbital implants” so they are longer than is usual which I now think was a mistake.
A: Thank you for sending your pictures. The basic concept is that you are going to have to undo everything that was done to do infraorbital implant removal. In addition there is little guarantee that you will return to your preoperative eyelid shape state.
These two concepts should give you great pause at this early point after surgery in having a reversal/removal procedure. Any implant edges that you feel now with time will not likely become less. They over time indeed may become more prominent. But no one can predict how you will feel about it months from now…which is the time one should allow for full healing to occur.
The ‘mistake’ that is often made in infraorbital implants is using preformed implants. The tissues are too thin and the implants are standard shapes, a set up for implant edge capability and potential visibility. This is what I almost always use custom implants or ePTFE sheeting which allows for very feathered implant edges and a better blending into the surrounding bone margins.
Dr. Barry Eppley