Custom Infraorbital-Malar Implants

Dr. Eppley, I am considering custom infraorbital-malar implants. Currently I have orbital rim implants that are of silicone material but they are not fixated with screws and are an off shell product. I think it gives a good improvement of my flatness under my eyes, but they are a bit uneven because of the different sides of my face as they are not completely symmetric. The right implant is actually perfect, but the left is kind of strange as it seems like it sits a bit lower and it has a lump that goes outward close to my nose, and there is a gap between the implant and the lump that creates a crease. Its almost like the implant are in two parts on this side.

I have a couple of questions to you regarding the custom infraorbital-malar implants that I was hoping you could answer.

1. Have you done a lot of these implant operations before? Are you very experienced in it?
2. As I have two sides of my face that are not completely symmetric, would you custom make the implant to the different sides to try to achieve more symmetry?
3. What kind of material are the implants of?
4. How long is the surgery time expected for this?

Looking forward to your answer, as I’m very pleased with the orbital rim implant I have, but I don’t like that they are not fixated and they are a bit asymmetric with the crease and lump on left side. I want a permanent safer, smoother solution that also will cover more of my malar region as well.

A: My first comment would be that if you are largely satisfied with your current standard orbital rim implants, I would be cautious about making any change. As a general plastic surgery philosophy, ‘perfection can be the enemy of good.’ That being said, if you were to consider a change the only way you should do it is with a custom implant approach as this would be the only method that has any chance of taking a result that is largely good and trying to make it better. In answer to your custom infraorbital-malar implant questions:

1) I am very experienced with custom facial implants including having done many custom infraorbital, malar and combined infraorbital-malar implants. (the latter is the most common when using a custom implant approach)
2) In using a custom implant approach, symmetry is exactly one of its benefits. The computer can see the differences on your 3D CT scan in bone between the two sides as well as your current implant positions and shape and take all of that into consideration when designing the implants.
3) The custom implants I use are made of silicone.
4) My assistant will pass along the cost of the procedure to you on Monday.
5) This surgery takes 1 1/2 hours to complete.

Dr. Barry Eppley
Indianapolis, Indiana