Are Custom Infraorbital-Malar Implants A Good Treatment For My Deep Dark Circles and Tear Trough Problems?

Q: Dr. Eppley,I have been searching extensively for a plastic surgery solution to my deep dark circles/hollow tear trough problem since i was young. I do not desire fillers or fat transfer because of the impermanence and unpredictability of the procedures respectively. I came across infraorbital rim implants which seem to have a beautiful and permanent aesthetic outcome. I was told by a dermatologist that the source of my deformity was a lack of sufficient bone structure around the eye region rather than tissue loss/migration. I read in a research article that an abnormally connected orbitomalar ligament can also play a role, where release may be necessary to correct the depth of the indentation. Furthermore, I read about the various customizable implants on your website and thought it would be perfect for me as i desire volume to be restored under my eye as well as an extension into the malar region to give me a more chiseled cheekbone projection that i am lacking. The tissue around this area appears to have a flat/sagging appearance because it doesn’t seem like there is enough support holding it up until i artificially mimic the motion with my fingers and lift up my cheeks. Please let me know if the implant would be suitable or if something else could be done better. I also desire more symmetry in my face as I have noticed that one side appears to be more developed than the other. I do not know exactly what procedures can correct this, as I haven’t researched too much into it, but if you can recommend something that wouldn’t be too surgically aggressive, that would be helpful for me. I’ve looked through many photos of your work and I greatly appreciate your aesthetic outcomes. I’ve attached two photos for reference of myself. Thank you very much

A: You have correctly identified the proper treatment for your undereye hollows/tear troughs….infraorbital rim augmentation. The only debates are: 1) whether standard vs custom infraorbital implants are to be used (see attached) and 2) whether there should be a malar extension to them or not. The first one is not much of a debate as when you have known asymmetry beforehand using standard implants will almost always make the asymmetry appear more pronounced. That combined with the need in infraorbital bony deficiencies to add both horizontal projection and vertical rim height, only a custom infraorbital rim implant can make those dimensional changes. As for any malar extension to the infraorbital implant that is an individual aesthetic decision of which you have stated that would be a good addition for you..