Are Tear Trough Implants Right For Me?
Q: Dr. Eppley, I had malar and para-nasal implants, also infra-orbital porex placed in 2006, and six months ago removed because the malar increased my gaunt look, provided only lateral projection, and started to show through my thin skin. The paranasal implants didn’t really do much for me in terms of anterior volume, since they were placed so low on my long face. Also, right infra-orbital implant became infected during removal of the malar implant and was also removed. Now I’ve got the left one still in there and, without the malars, the edges are poking through and it’s too small for my face. I trust my original surgeon and he wasn’t the one who removed the malar implants for financial and geographic reasons. Although the malars were kind of cool and from some angles gave me an “actor” look butI don’t want to replace them alone.
But, I do want to explore all options. That said, his idea is: 1) larger medpor tear trough plus midface lift. I realize the right eye is drooping. I also think there is some scar tissue where the paranasal was on right side that makes that cheek droop more and look puffy. I know that midface lift means basically 2-month initial recovery and can leave one funky-looking, and seems to not really last that long. I was thinking of the blepharoplasty to reposition the eye, instead??? (less invasive??) I like the idea of tear trough improvement , now that I can compare left vs. right, I see that my face needs it.
The groove and shadows beneath eyes are my biggest complaint. Because I realistically, with my long and gaunt face because of exercise, it would take a lot to fill it out. So I think a compromise of concentrating on eye area is the best option at this point. But I don’t want to go thru that recovery time and cost of the midface lift if it is going to fall in a year and the tear trough won’t be big enough and will start poking through….2) another surgeon I have worked with in past suggested malar-submalar combo, goretex. But is worried that any implant will just show through. I am also open to this, to give some structure to my flatness, lower healing time, lower cost. 3) This second surgeon prefers just to use injectables. I won’t do fat transfer because I will burn it off and it’s a waste of money and time. It would just leave the left infraorbital implant in and try to compensate on right and in lower cheeks with filler under eye. At this point, though, I would be looking at minimum $6000 in filler.
I had noticed the medpor porex tear trough implant and that, based on the brochure, seems to be what I’m looking for in terms of volume. But, I don’t think my present surgeon would go for something this big,and he had mentioned the Hoenig model. Again, anything anterior he is against in order to avoid hitting the nerve.
I’m not against the midface lift, but at this point would prefer to save any lifting for a mini-lift 5 years down the road, perhaps with submalar added…. with skin excision not just suspension, when I really need it. And for the massive recovery time. But, I have seen some awesome B & A of tear trough shadow improvement.
I don’t know…???? I started on this porex implant road and maybe just have to continue in this direction.
A: In answer to your questions:
1) Don’t do a midface lift. This is a longer recovery than most patients realize and with your facial skeletal structure you are at an increased risk of creating lower eyelid ectropion or an unusual look. With your thin facial tissues, you are always going to be at risk of tear trough implant palpability, visibility or asymmetry. But I can get more enthused about tear trough implants in you though than a midface lift.
2) A small thin malar shell implant for the cheeks is reasonable and far preferable to a midface lift. With your thin tissues there is not much room for error about implant size as it is easy to end up in you with a visible implant look as you have had in the past.
3) Injectable fillers or fat in your thin face will not only not work well but has a poor return on investment over time.
4) There should be no concern about ‘hitting’ the infraorbital nerve going over the edge of the infraorbital rim. The nerve is well below it. That appreciation is just a function of having placed implants there before.
Dr. Barry Eppley