How Can My Orbital Rim Step-Off Be Filled In?
Q: Dr. Eppley, I have a step-down of about 3-4mm from the rim of the orbital bone under my eyes straight down to the eyeball. There is no fat. Post after blepharoplasty about 6 years ago. I don’t like the look. Any help available? I am 56 years old and healthy with good skin. Thank you.
A: With the loss of fat, either through surgical removal, aging or a combination the edge of the lower orbital rim is now skeletonized. There are three approaches to consider for obliteration of this orbital rim step-off with the underlying theme that they all add volume but do it in different ways. I will first mention synthetic injectable fillers but this is not really on my list of sustainable long-term approaches.
Replacing what has been lost, fat, constitutes two of the orbital rim augmentation approaches. Fat injections are a well known option which is principally marred by the unpredictability of such fat grafts. It is however the simplest and least invasive approach. The other way to add fat is through dermal fat grafts, like a natural implant, placed along the inside of the orbital rims done through your existing blepharoplasty scars. These fat grafts take remarkably well but do require an open approach and a harvest site which is usually from the abdomen or from any existing scar that you may have on your body.
The other implant options are synthetic orbital rim implants that are made for exactly this area. Like a dermal-fat graft, they are placed through a lower eyelid incision and are secured to the bone with 1mm small screws.
Dr. Barry Eppley