What Is The Best Approach For My MIdface Rcession – Implant or Fat Grafting?

Q: Dr. Eppley, My maxillary atrophy was evaluated with an overlay technique using a 3D Ct scans ten years apart. The overlay came back as orbital-malar and midface bone koss. One plastic surgeon recommends fat grafting because I  have thin skin undereyes yet another surgeon said only after implant augmentation if I feel needed and he’s not worried about thin skin.

A:Based on your inquiry I’m not exactly sure what you are trying to accomplish. Are you trying to augment the maxilla where you have the atrophy or are you trying to augment the entire mid face including the infraorbital-malar region as well under the eyes. While I’ve only seen a front view picture you certainly have a negative orbital vector which is pretty common when you have generalized midface recession regardless of its origin.

Knowing what do you want to augment exactly makes the difference between a custom midface mask implant design versus an infraorbital–malar implant or an isolated maxillary implant.

Regardless of the midface area to be augmented it is certainly accurate that fat grafting would not be a good primary choice of treatment. Even if the fat survives you are  just going to end up with a bloated midface with persistent lack of any undereye support. Fat grafting is almost never a good solution for s facial bone problem.

Dr. Barry Eppley

Plastic Surgeon