Custom Infraorbital-Malar Implants

Q: Dr. Eppley, I am going through with custom infraorbital-malar implants from a CT scan. However, I am afraid that the prominence of the custom implant would be too much at 5mm. 

1.Is there a general reference for when implants would be extreme when looking at the skull, similar to where mandible angle implant width is considered extreme if it extends pass the zygomatic bone/arch?

2. Is it a bad idea for a surgeon to custom shave down a cheek implant further if it looks too prominent during surgery, even thought the implant was custom designed/fitted already? (I.e good chance of creating an abnormal shaped cheekbone?

3. I heard that custom designed implants at 5mm are more similar to the projection of off shelf implants of 3-4mm, since they have no space between the bone and implant. In general, have you noticed a 5mm custom designed malar implant to be less noticeable/prominent than a 5mm off shelf implant?

4. How much do you charge for a custom infraorbital-malar implant with both the payment to moldhouse and the expense for you to place it?

A: In answer to your custom infraorbital-malar implant questions:

1) For the midface there are no specific skeletal landmarks to keep an implant’s projection inside the ‘aesthetic window’.

2) If the surgeon feels the implant looks too big or unnatural in the cheek area after it is placed, it would be prudent for an adjustment by shaving reduction to be done at that time. I have done that many times as it is far better to have an implant that may end up slightly too small thank one that is too big. The latter has a 100% chance of revision.

3) I have never seen nor have any biologic rationale to the cheek implant comparison you have referenced. In fact it is quite the converse, custom cheek implants can much more easily be oversized compared to standard cheek implants because they cover a much greater surface area and thus their volumetric effects are more profound.

4) I will have my assistant Camille pass along the cost of the surgery to you later today.

Dr. Barry Eppley
Indianapolis, Indiana