What Is The Risk Of Developing Lid Retraction From Placing Custom Infraorbital-Malar Implants Through A Lower Eyelid Incision?
Q: Dr. Eppley,I am slightly concerned about the eye incision for the infraorbital-malar implants:
- 1) What are the reasons for not inserting them through the mouth?
- 2) What types of patients are more at risk of developing lower lid retraction?
- 3) Are patients with darker skin tones more likely to develop lower lid retraction?
- 4) If lower lid retraction does happen, are there any procedures that can be done in the future to help improve their appearance?
A: In answer to incision questions about the the infraorbital-malar implants:
1) When placing the implants through the mouth the risks of infection, implant malposition and permanent numbnerss of the infraorbital nerve are dramatically increased. Have done that many times and seen all of these issues it is not an approach I will ever use again when the eyelid incision has virtually none of these issues.
2) The risk of lid retraction is very low in this procedure because it is a non-excisional tissue access approach usually done n young people with good lower lid tissues and canthal support…and infraorbital rim support is being added.. This should not be confused (which it often is) with a traditional lower blepharoplasty done in older patients with weaker lid support and where lid tissues are actually removed. The few times I have ever seen any lid retraction is if a postoperative hematoma has occurred or the infraorbital rim is raised excessively high in close proximity to the incision location.
3) Skin pigmentation does not increase the risk of lid retraction or adverse scarring in my experience.
4) The treatment of lid retraction is well established with release, spacer grafts and canthopexy/canthoplasty as effective techniques.
Dr. Barry Eppley