Orbital Rim Implants
Q: Dr. Eppley, I have been looking into various procedures for augmentation of the upper face as the area surrounding my eyeballs is recessed in relation to the eyes. It is my understanding that the area surrounding the eye is comprised of the brow ridge (superior orbital rim), the lateral orbital rim (bone that extends from the edge of the brow ridge) and the inferior orbital rim (area under the eyes). One area which I am not sure about is the boney area that stretches around the side of the eye before joining the inferior orbital rim area, what is this bony area called?
I know that this entire skeletal area can be mobilized with the Le Fort 3 procedure, however this is not something that I would like to pursue due to the risk factors involved. My question is to what extent the effects of a Le Fort 3 can be replicated by the use of custom made implants? I know that implants can be used for anterior projection of the inferior orbital rim and the cheekbones, and that custom brow ridge and custom lateral orbital rim implants can be made. However, is there any way to advance the area of bone directly horizontal to the outside corner of each eye, to ‘encapsulate’ the eye so to speak from that side? Also, to what extent can the inferior and lateral orbital rims be reasonably advanced without it looking unnatural or proving problematic? Finally, what is the most economical way of combining custom implants to provide a total augmentation effect? So can a combined brow ridge and lateral orbital rim implant be fashioned etc.?
A: The inner orbital area is not a rim area per se. Rather it is comprised of the nasal and lacrimal bones as well as the frontal process of the frontal bone.
A LeFort III procedure does not change the entire orbital rim area. Rather it is a naso-maxillary-inferior orbital rim skeletal advancement. While this can be good procedure for you get children and even some adults that are affected by congenital craniofacial conditions, it is not an aesthetic procedure nor appropriate at any age for non-craniofacial anomaly problems for a host of reasons including its risks.
Custom onlay orbital rim implants would be the only way to safely and effectively augment all of these facial areas. The design of these type of orbital risk implants must take into consideration primarily how they would be placed (access incisions) and to make the augmentation look natural. That usually means not having them too big and having smooth transitions to the surrounding bone off the implant edges.
Such a ‘mask’ custom facial implant would be put in a segmentalized manner. How that would be divided is based on the access by which they are placed. Thus brow bone/lateral orbital rim, inferior orbital rim-molar, and maxillary-nasal base would be a three-piece approach to such a custom facial implant placement.
Dr. Barry Eppley