Does The Saddle On Custom Infraorbital-Malar Implants Increase The Risk of Double Vision?

Q: Dr. Eppley, here were a few questions I completely forgot to ask you about my custom infraorbital-malar implants surgery and was wondering if you could pass them along:

1. I had Photorefractive Keratectomy (PRK) surgery done several years ago to correct my myopia. Is this a problem with respect to my upcoming surgery with Dr. Eppley?

2. Regarding the implants: does adding the “saddle” to the implants create or increase a risk of blindness or double vision resulting from the surgery?

3. Would it be possible to get a quote for revision surgery that would be done in the event that I do not like the final result?

4. Just to make sure: will the “lateral” projection in the zygomatic arch region be 4mm, or 3mm as previously planned? It is a bit hard to tell from the 2nd IOM implant design document. I would like to keep the lateral projection in the cheekbone area subtle.

A: In answer to your custom IOM implant questions:

1)  The risks of any form of eyelid surgery after corneal reshaping is an increased risk of corneal drying should lid competence be compromised. (in the first 6 months after the surgery) This is more pertinent in traditional lower blepharoplasty where eyelid tissues are removed. That risk is significantly reduced when the lower eyelid procedure is one of access rather than tissue removal.

2) The saddle on the infraorbital rim has no risk of blindness or double vision. The saddle sits on the infraorbital rim and does not extend back onto the orbital floor.

3) Such a quote would rely on knowing what the revision would be for and how it would be done. That could be anything from the gamut of a lower lid adjustment, implant adjustment to implant replacement. That woulo be hard to predict before surgery if it  was ever needed.

4)  Currently that is 3mm but can be adjusted to less in surgery if needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon