Q: Dr. Eppley, I understand that you do infraorbital rim implants. (tear trough implants) I had malar implants placed last year, but it hasn’t provided the tear trough augmentation that I need. I also had some fat grafting to the tear troughs, and 2ccs of Aquamid (permanent filler) to each malar region. First, I have a hypothetical question. The surgeon who placed the Aquamid said that he injected it to the deeper tissue layers. Is there any chance that some (or most) of the filler could have been suctioned up in the process of placing the malar implants and creating the pockets? Secondly, I have lumpiness along my tear troughs from the fat grafting. I understand that an eyelid approach can be use to place the infraorbital rim implants. Would it be possible and convenient to also try and remove some of the fat grafts in the process? Lastly, I’ve always wanted to get a canthopexy. Would you recommend getting it done at the same time as the orbital rim implants?
A: One would never expect that malar implants would provide any tear trough augmentation so your experience is not unexpected. As for your Aquamid injections, i doubt that elevating the pocket for the malar implants removed much of the material but this is really a question that is better answered by the surgeon who placed the implants. Lumpiness from fat grafting to the tear troughs is not uncommon if they are not placed down as deep as possible along the orbital rim area. Whatever fat grafts are evident below the level of the orbicularis muscle during the placement of infraorbital rim/tear trough implants through a lower eyelid incision can be removed. When using the lower eyelid incision in implant placement, it is standard to perform a lateral canthopexy to prevent lower eyelid ectropion or a corner of the eye deformity.
Dr. Barry Eppley