Custom Malar Implant

Q: Dr. Eppley, I consulted with a plastic surgeon in January and he told me that I have an unusually low set zygomatic prominence. He suggested a custom malar implant. From your response I understand that it is indeed reasonable to reconstitute the malar prominence higher up on the face using a custom malar implant approach.. 

What I want to clarify in particular is what happens to the current zygomatic prominence? As you know it is important to maintain a natural shape to the cheekbones to avoid them looking fake. Assuming that I am not looking for any alteration to the frontal and lateral projection to the zygoma, would two malar prominences not look odd on the face? If it is contended that the custom implant would taper into the former malar prominence, I can envisage this creating an excessively large malar prominence which would run counter to the objective of a sharp, high set malar prominence.

A similar concern arises with respect to the lower border of the zygoma which would ordinarily sit beneath the ‘old’ zygomatic prominence. Can we literally remove this part of the zygoma by burring/shaving in order to raise that border to sit directly under the ‘new’ malar prominence?

A: I can only tell you what I would do…make a custom malar implant that sits high with an anterior infraorbital and posterior arch extension combined with an inferior triangular ostectomy of the lower portion of the zygomatic prominence combined with a buccal lipectomy. This is the most assured approach to maximize the likelihood that an inframalar concavity facial contour is created along with a higher cheekbone appearance.

Dr. Barry Eppley

Indianapolis, Indiana