Can Infraorbital-Malar Augmentation Be Done By Osteotomies and Bone Grafting?

Q: Dr. Eppley, I have a fairly recessed midface and orbital area. This is noticeable from profile and indicated by my negative orbital vector. It also results in the appearance of dark tear troughs under my eyes. I would like to fix this through any means possible. My problem is that I have a great aversion to implants. It is not that I doubt their effectiveness, I am just irrationally uncomfortable with the idea of having them in my face. Though I realize I may have no other choice than to ultimately go with implants… But in any case, my question to you is this: Could you perform any sort of osteotomy that would advance the infraorbital rims as well as possibly the malar-zygomatic complex? If so, I’m guessing it would be a lot more complicated and perhaps risky than simply getting implants, but I’d be very interested to hear about it and understand all my options. Thanks in advance.

A: As you have correctly surmised trying to achieve infraorbital-malar augmentation by osteotomies and/or bone grafting is fraught with many issues such as bony step-offs and  irregularities to name the most prominent of them. But their main aesthetic drawback is that moving the bone fails to raise the infraorbital rim which is a key augmentation dimensiona change needed in addition to moving to forward. in short trying to move the bone is both an inadequate solution as well as one that creates its own aesthetic issues.

Dr. Barry Eppley

Indianapolis, Indiana