Where Should The Maximum Malar Projection Be In Custom Cheek Implants?

Q: Dr. Eppley, I am wrapping up the research and design thoughts, I had two questions beforehand in regard to placement of the max projection area and rim coverage of the custom cheek implants.

  1. When researching the cheekbone I see the typical “max projection” area sits parallel at or in the middle of the infraorbital foramen with its height ending just a little below the infraorbital foramen.This is a screenshot from a friends CT Scan who has more prominent cheekbones though this seems to be common when I reviewed publicly available CT scans as well. On my design I see the max projection sits above this, would it looks more natural if it was positioned lower (taking into account in the new design I will be sending over soon I will be covering the lower portion of the malar region as well with the implant) or is this higher projection recommended
  2. I notice on some of your designs you cover the last third of the infraorbital rim on the inner eye. What are the benefits of this and would I benefit from it/would it improve the result?

A:The first question you ask defies a precise answer as it does not factor in the thickness of the overlying soft tissues nor the angulation of the cheekbone. So the effect of the relatively minor change in the location of the maximum projection of malar implants can not be precisely predicted for any patient a bed on their CTR scan alone.

Unless one wants to have the implants placed through a lower eyelid incision or go intraoral and risk permanent numbess of the cheek and upper lip it is best to avoid getting too much implant coverage in the medial infraorbital region. It is all about minimizing trauma to the infraorbital nerve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon