Custom Infraorbital-Malar Implants

Q: Dr. Eppley, I am a 24 year old male, and I am interested in getting custom zygomatic implants to augment my cheekbones. Reading through your site, I’ve come to learn that the key to the chiseled, high cheekbone look is to augment the zygomatic arch. So this is what I want to do. I also have a lack of projection in all directions of my zygomatic body and my infraorbital rim, so I want to cover those areas too. 

However there are a few things which I’m not clear about when it comes to cheek implants, and I thought you might be able to help clear them up for me. I’ll number the questions. I hope they aren’t too long. 

1) Angularity. I wanted to ask you how much the shape of the implant contributes to achieving the ‘angular’ look that a lot of models have. The angularity I’m referring to is where the zygomatic body progresses posteriorly into the zygomatic arch. A lot of models have an angular transition here. Would making the implant more sharper (slightly more square shaped) as it wraps around the zygoma help achieve this, or will this look unnatural? 

2) Anterior projection. I wanted to ask for your opinion on giving more anterior projection to the zygomatic body. In your opinion does this an anteriorly protruding zygoma look feminine? Basically I don’t want to divert attention away from the zygomatic arches by making the zygoma too big anteriorly, but at the same time I don’t want to miss out on the benefits of making my face look more anteriorly developed. 

3) Lateral projection of the zygomatic body? I’m confused as to whether it is desirable to laterally project the zygomatic body, or just the zygomatic arch. Would you be able to explain to me the aesthetic effects of projecting the zygomatic body along with the zygomatic arch, compared to just the zygomatic arch alone? 

4) Will it be possible to modify the implant at a later date by burring/shaving if there are some minor imbalances? 

5) The cheekbone ‘pop’ underneath the outside corner of the eye. A lot of models have this definable pop/prominence in this area. I’m trying to figure out how to achieve this. Am I right in saying that we would need to take into account the balance between the infraorbital rim and the zygoma, ensuring that the zygomatic prominence sticks out relative to the infraorbitals? I’m concerned that this will leave me with infraorbital hollowness. 

6) Frontal process of the zygomatic bone (inferior portion of the lateral orbital rim). Is it possible to include this area? I’m concerned that building up this area might make the zygomatic prominence look less developed (protrude less). Is this concern justified? 

A: In answer to your questions about custom infraorbital-malar implants:

1) The shape and dimensions of any custom facial implant are a major reason for the external facial shape seen. I would not make any such implant with a square shape as that would appear unnatural.

2) A high anterior zygomatic projection never looks feminine, you are referring to a low submalar anterior projection which does so.

3) You can not separate the lateral projection of the zygomatic body from the zygomatic arch. They are closely linked.

4) Revisions of custom facial implants are not rare since there is not accurate method to correlate the actual implant design to the desired outcome.

5) The implant design would extend up onto the lateral orbital rim.

6) answered in #5.

Dr. Eppley

Dr. Barry Eppley

Indianapolis, Indiana