How Can I Treat My Negative Orbital Vector?

Q: Dr. Eppley, I’ve been to so many doctors I’ve lost count as to how to fix my undereye hollows. Had them since I was young I’d do anything to get rid of themDo you work with 3D-milled PEEK or custom Medpor implants? Given how clearly I can feel my orbital rim, I’m concerned about the transition being seamless. How do you ensure the edges won’t be palpable?

A: Custom infraorbital-malar-maxillary implants are the only method to properly treat a negative orbital vector. Whether the material uses is solid silicone or PEEK as a matter of further discussion each of which has distinct advantages and disadvantages. As a general rule PEEK implants often are too small even when custom made to properly treat the negative orbital vector. This is why I prefer solid silicone in this area where  more sufficient designs can be used. I would never use  Medpor material in the periorbital area because it does not have fine edges and is a real problem for both  placement as well as subsequent removal or revision if ever needed.

Your case of negative orbital vector poses a special problem because you have a distinct lid – cheek groove (see attached picture) which would not be completely eliminated as the effects of the augmentation are largely above it. This would need to be treated with fat injections as a combination with the implant to try to reduce that line as much as possible.

Dr. Barry Eppley

Plastic Surgeon