Which is Better for Malar Infraorbital Augmentation – An Osteotomy or Implant?

Q: Dr. Eppley, I’m currently in consultation with regarding a malar infraorbital osteotomy. But given the risks of the procedure compared to implants, I’d like your opinion on how much augmentation we could achieve, the potential bone loss if using implants, and if the operation can be done intraorally among others

A: Thank you for sending your pictures. In answer to your infra-orbital malar augmentation questions:

1) Give your modest infraorbital recession which is very consistent with your ethnicity the concept of an osteotomy approach to treat it seems like a ‘solution that is bigger than the problem’.

2) How much augmentation that can be achieved and the incisional approach to place it are linked. To provide an accurate answer I would have to know the exact footprint of the implant (the exact outline of its bony coverage) The relevance of that, for example, is of the infraorbital rim needs to he saddled to any significant degree then an eyelid approach may be needed for its placement.

3) The concept of bone loss around facial implants is a fallacious one. More accurately there can be passive bone adaption to a facial implant based on where it sits. This process is completely benign and self-limiting. But even this is not a biologic phenomenon I have seen in the midface across the orbital rims or cheeks.

Dr. Barry Eppley
Indianapolis, Indiana