Infraorbital Rim Implants

Q: Dr. Eppley, I have a severe tear trough deformity and am interested in the implant procedure. However there does not seem to be anyone in my area that will use implants for correction????

A: Thank you for your inquiry and seconding your picture. I think you are referring to a complete infraorbital rim implant not just a tear trough implant which just covers the inner half of the orbital tim. While most plastic surgeons prefer fat injection grafting for a deficient infraorbital rim, I prefer an implant rim augmentation technique which produces a more reliable, smooth and permanent result. This is a vey rare type of facial implant that is used only by experienced facial implant surgeons. While the technique to place them is the same (lower eyelid incision), the design of the infraorbital rim implant varies. It can be made as a custom implant from the patient’s 3D CT scan or can be used as a ‘semi-custom’ type implant which is a derivative from prior custom implant patients. (infraorbital rim anatomy/shape is not that different amongst most patients) There are no performed or standard off-the-shelf infraorbital rim implants for use…which is also why there are so few surgeons that use or have any knowledge about them.

When in doubt about using infraorbital rim implants, one should always try fat grafting first. There usually is little to lose by doing so as fat often completely resorbs in the infraorbital area. If it is overdone and too much fat persists then infraorbital rim implants can be placed and the extra fat removed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana