Custom Infraorbital-Malar Implants

Q: Dr. Eppley, I am interested in custom infraorbital-malar implants to replace my existing tear trough implants. Your initial statement about that I have to be careful when the result is “good enough”.But there is a couple of things that bother me with the current orbital rim implant.I already described the uneveness of the implants on the sides, but there is also this concern that the implant is not fixed. I’m a bit afraid that the fact that its not fixed could lead to some erosion,and that it would be better if it was fixed.

When you talk about the making of the custom implant, are you saying that a x-ray scan can detect the underlaying bone structure I have under the implant? So this would mean that there is no need to take the implant out first and then take pictures, but you can actually detect the structure under the implant and make a custom implant out of that information? If thats the case it would be a relief.

The surgeon that put in my current orbital rim implant said to me that he would not advice me to do another cheek implant surgery as this would be risky.

Again. thank you for being such a great doctor and giving me such detailed informative answers.

A: Custom infraorbital-malar implants are made from a 3D CT scan of the patient. From this scan the current size/shape/position of the orbital rim implants can be seen as well as that of the underlying bone. To make the custom implants the old implants are digitally removed for the new designs. Thus you do not need to have your old implants removed first, the computer program does it. The really informative thing is then the new implant designs are overlaid digitally on top of the old implants. (in different colors) By so doing the two implants can be compared and one can see both the differences as well as to keep the good things about the current implants and have the new implants cover the areas that the old one don’t.

There is nothing medically risky about a second surgery to remove and replace your current implants. The risks are really aesthetic in nature. But you can see that the custom implant approach would be the only way to lessen/eliminate those risks and give you the best chance to go from a good result to a better one.

Dr. Barry Eppley
Indianapolis, Indiana