How Can My Unsatisfactory Orbital Rim Implants Be Improved?

Q: Dr. Eppley, Thank you very much for your detailed explanation and for clarifying the situation with my current Medpor cheek implants. Based on this information, I would like to kindly ask:

Given the specific models, what options would you recommend in my case?

Do you think it is possible to design and place new, better-fitting implants that could solve the current problems?

My main concern is to understand what is realistically achievable and whether you feel confident that you could help me in this situation.

Thank you again for your time and guidance. I look forward to your opinion.

A:Thank you for sending your additional information. These are classic Medpor inferior orbital rim implants, which only come in 3 mms of horizontal projection, that have been placed intraorally with double screw fixation on the side as seen in your 3-D CT scan. As I have seen many times for these implants they create both a ledge and do not improve or increase under eye hollowing. As I probably previously stated you can’t simply add horizontal augmentation to the infraorbital area, a 2-D solution, for undereye hollowing, which is a 3-D bony problem.

To provide improvement of the result that you currently have these implants need to be replaced with custom infraorbital rim-malar implants that provide a 3-D augmentative effect. These are placed through the lower eyelid which is a direct approach to implant placement and being able to place an implant that actually saddles the rin. Your existing Medpor implants will need to be removed exactly the same way in which they were placed, intraorally, as the screws have been angled in from that direction and cannot be removed from a superior eyelid approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon