What Type Of Midface Implants Do I Need?

Q: Dr. Eppley, I am interested in midface augmentation using malar shell implants but I have not yet had the procedure because of certain concerns. I am concerned about the submalar fullness which I had noticed in photos of female patients who have had the submalar cheek implants placed. Although I definitely have the concavities in the submalar area which would benefit from some augmentation, I did not want “apple” or “cherub” cheeks. (Check out Barry Manilow’s face now). This type of fullness can look artificial and certainly looks better on females than males. I know that the implant can be modified by removing some projection from the underneath side of the submalar portion of the implant.  Of course, a lot would depend upon how much fullness is already present in the submalar area. I am also unsure of whether the implant would make my face look wider and somewhat “chubby” rather than more sculpted (more attractive on males).  I have a round face lacking in strong structural features. But I was not so sure about what the midface augmentation would accomplish .  In addition, the lower eyelid area concerned me.  Actually, I thought that if the midface implant were placed high on the bone close to the orbital rim, it  would have the nice collateral benefit of minimizing the tear trough area, but I did not know how much an improvement this would be, given the design of the implant. 

A: In looking at your face and all the current styles of performed midface implants, none would be appropriate for what you are looking for. You are correct in assuming that your face would get wider  and would dimensionally change you in the wrong direction. What you need is more anterior or forward projection across the orbital rims and down onto the face of the maxilla. This is actually the ‘missing’ zone of facial augmentation in regards to current implant designs because it is concave facial area and not a convex one.

What you really need is an orbito-maxillary facial implant that improves midface projection but not malar width. This can only be properly designed through a custom implant approach based on a 3D CT scan.

Dr. Barry Eppley

Indianapolis, Indiana