Custom Infraorbital Cheek Implants and the Lower Eyelid Incision

Q: Dr Eppley, I am interested in custom infraorbital cheek implants. However, I have scleral show and don’t want to run the risk of amplifying it through insertion via the eyelid. Could the custom implant be inserted though the mouth? Thanks.

A: The intraoral route for custom infraorbital-malar implants can be used IF the implant is not designed to saddle the orbital rim and only provides some minimal anterior projection. If it needs to saddle the orbital rim to any degree, and most such custom implants do which is why they are custom, then a lower eyelid approach is needed ensure adequate placement.

Custom infraorbital implants that saddle the orbital rim and add height to the bone are actually an effective treatment for scleral show as they drive the lower eyelid upward.

Dr. Barry Eppley

Indianapolis, Indiana