Q: Dr. Eppley, I am a 32 year old male and have been interested in seeking surgery to improve the area surrounding my eyes without detracting from my masculine features. I have searched tirelessly to find an oculpplastic surgeon which will help me achieve my desired result without feminizing my face. This search has involved me meeting with a number of surgeons, none of which are familiar with inferior orbital rim implants. It has been recommended that I would benefit from upper and lower blepharoplasty with arcus marginalis release and fat transposition. It has also been proposed that I would benefit from malar implants to address my flush cheeks. I am particularly interested in skeletal augmentation with inferior orbital rim implants and malar implants- do you practice with these techniques and implants?
A: As you are aware there are different techniques and surgeon’s have different philosophies as to how to manage the deficient lower orbital rim/tear trough deformity. But when combined with a more recessed malar prominence, this indicates there is an overall infraorbital-malar deficiency. When the underlying skeletal deficiency is more extensive, as you have described, I would agree that a skeletal augmentation approach is the more effective and better long-term solution. In my experience, I treat these skeletal deficiencies with a combined Medpor malar-infraorbital implant placed through a lower eyelid incision. This is the best style of implant that I have ever used for this exact problem. I have placed this implant through an intraoral approach but it is very challenging to get it positioned properly above the infraorbital nerve. The maximum projection of this implant at its malar portion is 4mms which is usually adequate for most patients.
Dr. Barry Eppley