Your Questions

Q: Dr. Eppley, I have been told by another physician that infraorbital rim implants would benefit me.  I have dark circles that have really been developing a lot under my eyes and have had Restylane with little effect (just one treatment).  I am hoping for a more permanent solution.  Do you agree it could benefit me?  Can this procedure be done under local anesthesia?  What is the approximate cost of this procedure?  I have attached my photos.

A: I would agree that you are a good candidate for combined infraorbital rim-malar implants given your anatomy and the lack of success with injectable fillers. Both your cheeks and your lower orbital rims are retrusive in position. From the side view you have a negative vector, meaning the cornea of your eye sticks out further than the cheek-lower eye socket bone. This is an anatomic sign that bony augmentation may be aesthetically beneficial. The placement of orbital rim implants can be done in two ways, either through a lower eyelid incision (preferred) or from an intraoral approach. Better implant placement and less risk of injury to the infraorbital nerve is ore assured with a lower eyelid approach. Either way the procedure can NOT be done under local anesthesia under any circumstances. The approximate total cost of the procedure is around $6500.

Dr. Barry Eppley

Indianapolis, Indiana

Q: D. Eppley, I am a 30 year old and have had prominent eyes that are congenital but not hereditary. I have no medical problems and the thyroid readings are normal. My eyesight is very good. I have a negative vector and shallow orbits . Will I need both cheek and orbital implants? Could you please give me an idea of the nature of the implants before I come down to your clinic. Thanks

A: When one has pseudoproptosis (eyes that appear to bulge out but actually are normal in position but the bone around them is deficient), the consideration of orbital rim augmentation with implants is a reasonable one. Whether the orbital rim or the rim and the cheek needs to be built up is a matter of one’s anatomy. In most cases, significant orbital; rim hypoplasia is accompanied with an underdeveloped cheek as well. This is where the use of a combined orbito-malar implant can be most beneficial.

Dr. Barry Eppley

Indianapolis, Indiana