Cheek Implant for Lower Eyelid Elevation

Q: Dr. Eppley, I was told a cheek implant is necessary to elevate the lower eye lids to shape it more lateral to create this look. I am not sure how this makes any sense. While some also suggest that throwing in there a mid face lift can push the eyes as well to give such results. Another oculoplastic surgeon said that he likes to use grafts either from the mouth or alloderm as such drastic lateral canthoplasty will take more than a canthoplasty and also he mentioned the orbital bone and cheek / facial structure needs to be assessed in order to create such looks that my cousin and I are seeking. Something about how the cheek implant can create a desired look of this. 

I am not sure if the photos were attached however I will attach them again. I hope this is something we can potentially convince you to do as we wish to boost our potential as models in our hobby. We would love to visit you personally but we are dispersed around other states as college students. So if possible let me know if the results are permanent and if this is something relatively easy fr you to do and if a cheek implant is necessary. 

A: A cheek implant has nothing to with influencing the position of the repositioned lower eyelid. What is more useful is an interpositional graft like Alloderm as the eyelids need more tissue internally. Just stretching them upward alone with a lateral canthoplasty will develop some relapse because a truly elevated and sustained eyelid position ultimately needs more tissue.

While a cheek implant has nothing to do with the sustained position of the outer corner of the eye, it is needed if one wants a higher cheekbone look which is a separate but related aesthetic issue by proximity. The only implant that can help the position of the lower eyelid is a true infraorbital implant. But it does not negate the need for an interpositional lower eyelid graft.

Dr. Barry Eppley
Indianapolis, Indiana