Can Intraoral Placement of Infraorbital-Malar Implants Avoid The Need For Any Lower Eyelid Procedures?

Q: Dr. Eppley, i have a bit of lower eyelid retraction on my right side and was considering getting custom zygoma/cheek implants anyways (placed intraorally). If i extended the implant onto the infraorbital rim, increasing its vertical height by 1-2mm, could this eliminate or improve the retraction and sclera show without any canthoplasty, etc? Thanks

A:Lower eyelid retraction is a soft tissue structural deficiency most commonly associated with an underlying skeletal deficiency. So you are partially correct in that infraorbital rim augmentation may be helpful improving the position of the lower eyelid, although by itself that would be very modest. However the key to such infraorbital rim augmentation in a case like yours is that the implant must vertically heighten the rim by saddling  along the infra and lateral infraorbital rim areas. Such an infraorbital – malar implant design is extremely difficult to successfully get it into proper position through an intraoral approach for two reasons: 1) the large infraorbital nerve is in the way which sits right below the rim and 2) getting over the edge of the rim to successfully release it on the inside to allow for proper implant positioning coming from below is the wrong direction to do the dissection. Any infraorbital rim implant you see placed intraorally never saddle the ram, they merely sit in front of it only providing horizontal augmentation.

In short the only real way to get lower lid retraction of any significance is to place the implant through a lower eyelid incision in which you might as well place a spacer graft and perform a lateral canthopexy for to be really successful.

The only reason to place an infraorbital-malar implant through intraoral approach is if the goal is to primarily augment the rim and cheeks in a horizontal fashion and any improvement of the lower eyelid, limited as it may be, will only be seen as a secondary bonus.

Dr. Barry Eppley

Plastic Surgeon