Can Infraorbital Rim Implants Help After Jaw Surgery?

Q: Dr. Eppley, I underwent upper and lower jaw surgery over one year ago. The surgeon did a fairly good job advancing my lower and upper jaw, however, it has (if anything) accentuated the deficiency around my orbital area. I have very deepset eyes, which could pose a challenge with this sort of procedure. What are your initial thoughts – and do you have a lot of experience with infraorbital rim implants?

A: It would not be rare to develop an infraorbital rim deficiency after a lower maxillary/mandibular orthognathic surgery procedure. As the bones are moved below the orbital rim, how that area looks will be affected based on the lower facial skeletal movements. Infraorbital rim augmentation can certainly be done but the relevant question, as you have pointed out, is how will that affect the already appearance of deep set eyes. Will doing so be an aesthetic improvement or not? I have performed numerous orbital rim augmentations either alone or as part of custom malar-infraorbial rim implants. There are different styles/shapes between preformed off-the-shelf and custom infraorbital implants. Off the shelf infraorbital rim implants are designed to augment the front edge of the rim (sit in front of the orbital rim) and, in deep set eyes, such isolated horizontal augmentation may make the eyes look more deep set. In more custom designs, the infraorbital rim augmentation sits more on the top of the orbital rim with some slight overhang, causing a slightly different and more natural effect in my opinion and one that is less likely to cause an adverse effect on your eye appearance. These custom designs also flow into the cheek area with a smooth transition, providing as much augmentation effect in this area as the patient prefers. (or prefers not to have) As an initial thought on what make happen with infraorbital rim augmentation, I will do some computer imaging and get that back to you later today. At this point, I could not tell you whether this would be a favorable facial skeletal change or not.

Dr. Barry Eppley

Indianapolis, Indiana