How Are Custom Jawline and Infraorbital Malar Implants Placed?

Q: Dr. Eppley, I am interested in custom jawline and custom bilateral infraorbital malar implants. How are the implants placed? Would they all be through the inside of the mouth or would the infraorbital implants be done through the lower eyelid? I don’t want my eye shape to change or for there to be an increase in sclera showing – is this something you’re always able to avoid?

Thank you,

A: A custom jawline implant in a male is typically placed using three incisions, two in the back of the mouth and one from outside under the chin. The combined infraorbital-malar implant is typically placed through the lower eyelids…unless it has only a very small infraorbital extension and/or does not saddle the infraorbital rim.

The most common use of lower eyelid incisions by plastic surgeons is in older patient with lower blepharoplasties where tissues are removed of which increased scleral show or lower lid margin rounding is a well known risk and is not a rare postoperative development. It is very different in young people who have stronger tissues and a stout lateral cantonal tendon who get custom implants where no tissues are removed and lower eyelid support is being added. As a result increased scleral show is not an expected problem and often the reverse occurs…an elevated lower eyelid or decreased scleral show. (if it existed beforehand)

Dr. Barry Eppley

Indianapolis, indiana