Why Did My Custom Infraorbital Implants Not Correct My Undereye Hollowing?

Q: Dr. Eppley, I got custom infraorbital implants to correct my undereye hollowing which it did not do. I have attached the implant design file.

A:Just because implants were made custom does not mean they are going to create the desired effect. Besides accurate placement the other major component of an aesthetic outcome with custom implants is their design in terms of surface area  coverage and various thicknesses throughout the implant. My first question when I see someone who has had custom implants that did not create the desired shape or created and the fact that they did not anticipate is…. what was the basis of this implant design? Why was this implant designed this way and what were the original objectives?

As I am not privy to all of that prior information I can only look at the current problem… which is persistent under eye hollowing. While this implant design does cross the infraorbital area it only provides horizontal infraorbital rim augmentation which will either maintain or worsen the presence of any pre-existing under eye hollowing. To properly treat under eye hollowing the infraorbital rim area must be augmented both vertically and horizontally known as saddling the rim. This implant design does not do so and even though it provides infraorbital rim augmentation it never had a chance to improve under eye hollowing. This is a flawed implant design to achieve that effect. This undoubtably was done by a surgeon who has never used implants to improve under eye hollowing and tried to do so with an implant design placed intraorally. The only way to successfully treat under eye hollering is an implant design that saddles the rim and is placed through a lower eyelid incision.

Given the benefits that your current implants provided in the cheek area my tendency would be to design new implants that sit on top and round these existing implants place they will lower eyelid incision.. Stacking implants on top of each other has its potential disadvantages but in your case may be the most appropriate approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon