How Much Horizontal Projection Can Custom Infraorbital-Malar Implants Achieve?
Q: Dr. Eppley, I recently had custom infraorbital-malar implants placed for significant malar hypoplasia. Unfortunately I was underwhelmed with the anterior projection the surgeon designed as it was a just 4.5mm at its point of maximum projection. highest.
In your professional opinion, what is the maximum anterior projection in mm for infraorbital-malar implants that would look natural yet prominent in stature? I already had tear trough implants in the past and was underwhelmed by how little it affected the frontal view of my cheek area.
A: I do not have the advantage of knowing what you looked before surgery, what your overall implant designs looked like nor any of the thought process that went into the design of them. But as a general statement custom facial implants designs are always a bit of a ‘guess’ as to what will meet the patient’s aesthetic goals. No surgeon or patient can ever accurately predict what aesthetic outcome a first time custom facial implant will do. The design technology does not yet exist as to know after surgery what the exact aesthetic outcome will be. That is undoubtably why, in my extensive experience, that about 1/3 of all custom facial implants undergo revision or replacement surgery for under- or over correction issues.
That being said, you now have the insight of precisely knowing what the effects are of the implants dimensions that were chosen. That is a tremendous advantage in designing implant replacements. Speaking specifically about horizontal projection at the infraorbital-malar transition area, I have seen patients who ultimately required up to 10mms of projection. The key in having greater projection in this area is that the footprint of the implant would likely need to be greater to allow a smoother transition into the surrounding bone. (aka a natural look) Otherwise a shelf effect is created which would definitely look unnatural.
Dr. Barry Eppley