How Can I Solve My Prominent Medpor Infraorbital Implant Appearance?

Q: Dr. Eppley, A year ago, I had Medpor infraorbital implants placed to correct hollowing under my eyes. Unfortunately, I feel that the implants were not well suited – my facial proportions have changed, and the implants are visible beneath the thin skin of the lower eyelids. I have also noticed a deepening of the nasolabial folds, which I suspect may be related to their position being too close to the inner corners of the orbits.

Later, I underwent a temporal lift intended to cover the implants with soft tissue, but it did not bring the expected results – the implants are still visible. Another maxillofacial surgeon suggested that the best solution would be to remove the implants through an intraoral approach, the same way they were originally inserted. After the implant surgery, I also experienced prolonged swelling in the nasolabial fold area, which still concerns me.

I would like to know, after reviewing the photos of my face, whether the best solution in my case would be complete removal of the implants, or possibly replacing them with a different type positioned more laterally – in the zygomatic area. I am also concerned about the removal procedure itself, although I understand that it is performed in another tissue layer and should not lead to skin loosening.

It is very important to me to receive professional guidance, and I am considering entrusting this procedure to you, given your experience with similar cases. I am attaching photos taken before the surgery as well as recent ones, along with CT scan images (unfortunately, the implants are not visible there). In two weeks, I will also have an MRI done, and I would be glad to send you those results for additional assessment.

Thank you very much for your time and opinion. 

A:Thank you for your inquiry and sending all of your pictures. I have seen this problem many times and it typically occurs with the more bulky Medpor or PEEK implants because they are machined and do not have fine edges or contours. I don’t know whether these are standard and custom Medpor implants but the issue is the same as you have already correctly surmised… they are not well fitted for your face. The lower eyelid is a very unforgiving area due to the thin tissues and it doesn’t take much implant excess to have them appear as they do in you. You are, however, incorrect about the reason deepening of the nasolabial folds. It has nothing to do with implant location but in rigid Medpor implants it takes extended soft tissue tissue detachments for them to be placed. The need to detach all of the surrounding tissues has resulted in heir subsequent  soft tissue descent resulting in the now more apparent nasolabial folds.

The concept of performing a temporal lift to provide more soft tissue cover over the implants was a flawed concept from the beginning…it never had any chance to be successful.  The problem lies in the implant shape and design not the lack of adequate soft tissue cover.

When it comes for how to move forward there too obvious options. First there is complete removal of the implants which would solve the protruding appearance of them but I would have concerns that there will be more significant hollowing then you had initially. There undoubtably was a reason they were put in, which I assume was due to undereye hollowing, and that problem will likely be worse due to the trauma to the tissues as well as the stretch and detachment of them. A good rule  to remember about implants placed anywhere in the face and body is that once removed one never returns completely back to what it was before they placed. I do not know where your concept comes from for implant removal as it is performed in the exact tissue layer in which they were placed and it will definitely lead to more skin loosening due to the expanded stretch of the tissues. The question is not whether there will be more skin loosing but only how significant it may or may not be

The second option would be to have better design and implants with improved contours and edging. Ideally it would be helpful to see the implants on a 3-D CT scan as then a custom design could be made using that information… As the old motto in facial implants goes…. when you know why something doesn’t work you know how to make it work better the second time. In other words if you could see the implants you have in place it would be easy to design something better to solve the current problems you have. However the Medpor implant material can simply not be seen on a CT or MRI imaging from  a 3-D viewpoint which is the only information that would be helpful. I would not waste the effort on getting an MRI. I do not understand why that would be ordered or what is to be gained by getting it.

The most important imformation would be o know exactly the Implants that are in you which would be obtained from your surgeon by the operative note and/or a record of the implant style and size. The operative record is usually the most helpful.

Dr. Barry Eppley

World-Renowned Plastic Surgeon