How Can I Fix My Midface Fullness After Infraorbital Rim Implant Removals?

Q: Dr. Eppley, About one hear ago I had infraorbital rim/cheek implants placed. I had them removed 2.5 months after placement, and I am currently about 9 months post removal. 

I see you write extensively on how the soft tissue can lose its support and sag. However, while I can’t fully rule out sagging, I feel the biggest issue I have is residual puffiness that makes my mid face look bloated. 

My implants were not very thick (about 2mm), but they were large and covered a lot of area. Also my doctor told me he had to detach basically the entire mid face in order to get them in. I think as a result of this I have bloating even in areas below where the implant was. I’d say the worst area is nasolabial fat pad. 

In short though, I don’t feel that sagging is my issue because when I lift up my cheek tissues it doesn’t look natural and that does not seem to be the solution. I think the issue is simply that midface—particularly the fat pads—are more augmented than they were before. 

I imagine it’s a combination of scar tissue, capsule, and tissue stretch. 

I imagine with time a may still see slight improvements, but I was wondering if there is any non surgical solution to make my face look more chiseled and less bloated. 

Would C02 laser, thermage, or ultherapy help in tightening the soft tissue and making it more firm/less augmented and tighten the skin? And if so, which of these procedures would be best? 

Also, at 9 months post op is there even any chance more improvement will come with time? 


A: While you may not think it is tissue sag (it is definitely not tissue ‘bloat’) that is because pushing on the skin on the outside does not replicate moving up the scarred and lowered internal tissues (periosteum and SOOF tissues) from the initial dissection and release. They have slide down and are what creates the fullness. The proper time to prevent this issue was when the implants were removed (SOOF lift/resuspension) to avoid what could be predictably known to happen when the implants were removed. (the thickness of the implants does not matter, it is their surface area coverage and the tissues that needed to be released is what counts) What you have by now it what it is going to be. There is no non-surgical treatment that is going to solve this problem…although there is no harm in trying.

Dr. Barry Eppley

Indianapolis, Indiana